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Cryptogenic spontaneous subarachnoid haemorrhage
Clinical Neurology and Neurosurgery
|January 1, 1983
Summary
Cryptogenic subarachnoid hemorrhage (SAH) can be challenging. A cause, often a missed aneurysm, becomes apparent in 10% of patients within three weeks, after which the condition is typically benign.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Spontaneous primary subarachnoid hemorrhage (SAH) without an identifiable cause after initial investigation poses a clinical challenge.
- Cerebral four-vessel angiography is a key diagnostic tool for identifying the source of SAH.
- Cryptogenic SAH requires careful consideration due to potential underlying pathologies.
Purpose of the Study:
- To investigate the natural history and potential causes of cryptogenic subarachnoid hemorrhage.
- To determine the incidence of delayed diagnosis of causative lesions in SAH.
- To evaluate the long-term prognosis of patients with SAH where the initial cause remains elusive.
Main Methods:
- Retrospective analysis of 95 patients with spontaneous primary subarachnoid hemorrhage.
- Review of initial diagnostic investigations, including cerebral four-vessel angiography.
- Follow-up assessment of clinical evolution over time.
Main Results:
- In approximately 10% of cases, a cause for SAH became apparent within the first three weeks post-hemorrhage.
- Missed aneurysms were the predominant cause identified during this delayed diagnostic period.
- After the initial three-week period, the clinical course for patients with cryptogenic SAH was generally benign.
Conclusions:
- Cryptogenic SAH may represent a distinct clinical entity.
- The possibility of a missed aneurysm should be considered in the initial evaluation and follow-up of SAH patients.
- While often benign, the risk of aneurysm re-bleeding, though not explicitly stated as occurring in this series, remains a consideration in individual cases.