Subarachnoid hemorrhage with normal cerebral panangiography

Area of Science:

• Neurology
• Neurosurgery
• Critical Care Medicine

Background:

• Subarachnoid hemorrhage (SAH) is a critical neurological event.
• Cerebral vasospasm is a common complication of SAH.
• The role of antifibrinolytic therapy in SAH management is debated.

Purpose of the Study:

• To investigate the efficacy and safety of antifibrinolytic therapy in nonhypertensive patients with SAH and normal cerebral panangiography.
• To evaluate the impact of tranexamic acid on rebleeding and mortality.

Main Methods:

• A cohort of 42 nonhypertensive patients with SAH and normal cerebral panangiography was studied.
• Patients were followed for 1 to 5 years.
• Thirteen patients received tranexamic acid (Group A), while 29 did not (Group B).

Main Results:

• Five patients in Group A died due to cerebral vasospasm-induced ischemia.
• No deaths occurred in Group B.
• No early rebleeding was observed in either group.
• Late rebleeding occurred in only one patient (2.4%) with normal cerebral panangiography.

Conclusions:

• Antifibrinolytic therapy is not indicated for SAH patients with normal cerebral panangiography.
• Tranexamic acid may increase the risk of mortality from cerebral vasospasm.
• Routine reangiography after SAH with normal initial findings is not indicated.
• Most surviving patients achieve a good prognosis and return to work within 6 months.