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A Predictive Model for Distinguishing Non-Aneurysmal Subarachnoid Hemorrhage from Aneurysmal Subarachnoid Hemorrhage
Pichaporn Boonliang1, Amnat Kitkhuandee2, Waranon Munkong3
1Neurosurgery Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
World Neurosurgery
|April 12, 2026
Summary
Perimesencephalic subarachnoid hemorrhage (PMSAH), good World Federation of Neurosurgical Societies (WFNS) grades, and diabetes mellitus (DM) are key indicators distinguishing non-aneurysmal SAH (naSAH). A predictive model incorporating these factors shows high accuracy for naSAH risk stratification.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Distinguishing non-aneurysmal subarachnoid hemorrhage (naSAH) from aneurysmal subarachnoid hemorrhage (aSAH) is critical for patient management.
- Initial computed tomography angiography (CTA) can be negative in some SAH cases, necessitating further diagnostic approaches.
Purpose of the Study:
- To identify independent risk factors differentiating naSAH from aSAH.
- To develop and evaluate a clinical-radiographic predictive model for naSAH risk stratification, particularly when CTA is negative.
Main Methods:
- Retrospective analysis of 275 patients with spontaneous subarachnoid hemorrhage (SAH).
- Multivariate logistic regression was employed to determine independent predictors of naSAH.
- Model performance was assessed using the area under the receiver operating characteristic curve (AUROC).
Main Results:
- Perimesencephalic SAH (PMSAH), good World Federation of Neurosurgical Societies (WFNS) grades (1-3), and diabetes mellitus (DM) were identified as independent predictors of naSAH.
- A predictive model combining CTA negativity, PMSAH, good WFNS grade, and DM achieved an AUROC of 0.9587.
- When all three clinical features were present and CTA was negative, the predicted probability of naSAH reached 98%.
Conclusions:
- PMSAH, good WFNS grade, and DM are significantly associated with naSAH, increasing pre-test probability.
- While these factors aid in identifying non-aneurysmal cases, digital subtraction angiography (DSA) remains the gold standard for diagnosis.
- The developed model serves as a valuable supplementary tool for clinical counseling and guiding diagnostic urgency.
