[Management for subarachnoid hemorrhage with negative initial angiography]

Area of Science:

• Neurology
• Neurosurgery
• Radiology

Background:

• Subarachnoid hemorrhage (SAH) is frequently caused by ruptured aneurysms or arteriovenous malformations.
• Cerebral angiograms are standard for detecting SAH sources, but can sometimes fail to identify the bleeding origin.
• This study addresses the management of SAH cases where the initial angiogram is negative.

Purpose of the Study:

• To assess the management strategies for subarachnoid hemorrhage (SAH) when the initial cerebral angiogram does not reveal the source.
• To evaluate the outcomes of patients with negative initial angiograms for SAH.

Main Methods:

• Retrospective review of 12 subarachnoid hemorrhage (SAH) cases with initially negative cerebral angiograms.
• Cases were categorized into three groups: occult aneurysm, unknown etiology, and rebleeding.
• Analysis included clinical presentation (Hunt and Hess grade), radiological findings (Fisher group), and follow-up data.

Main Results:

• Occult aneurysms were identified in 6.3% of total SAH cases through repeated angiography or surgery.
• Patients with initially negative angiograms showed varied clinical and radiological profiles.
• One case resulted in fatal rebleeding, highlighting the risk associated with unidentified SAH sources.

Conclusions:

• Patients with SAH and negative initial angiograms should be managed as potential cases of occult aneurysm.
• Repeated cerebral angiograms, particularly around day 7 and between days 14-21, are recommended.
• Prompt identification and management of occult aneurysms are critical to prevent rebleeding and improve patient outcomes.