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[Subarachnoid haemorrhage with negative tomographic angiography without vasospasm: is it necessary to perform
1Hospital Universitario Virgen de la Arrixaca, El Palmar, España.
Introduction:
In about 15% of cases, the lesion causing subarachnoid haemorrhage (SAH) is not detectable by imaging studies, and some controversy exists as regards how the diagnosis should be performed in these patients.
Aim:
To analyse the diagnostic performance of digital subtraction angiography (DSA) carried out on a significant cohort of patients with SAH and negative tomographic angiography, without cerebral vasospasm, based on the distribution of bleeding in a simple CT scan.
Patients And Methods:
A retrospective analysis is performed of the centre's radiological database over an eight-year period. The inclusion criteria were patients with SAH of a perimesencephalic or diffuse distribution with a negative tomographic angiography result, without cerebral vasospasm, with at least one DSA control of the brain vessels.
Results:
A total of 125 patients met the inclusion criteria: 61 had a perimesencephalic SAH and 64 had a diffuse SAH. The first DSA revealed vascular injury in seven patients (5.6%): one was in the perimesencephalic SAH group (1.6% yield) and six in the diffuse SAH group (9.4% yield). A second DSA was performed on 86 patients, a third on 28 and a fourth on five of them.
Conclusion:
The absence of vasospasm in the first DSA performed in patients with SAH and negative tomographic angiography could be a useful criterion for establishing an optimal follow-up protocol in these patients, without exposing them to unnecessary risks and radiation.
