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Aneurysmal and microaneurysmal "angiogram-negative" subarachnoid hemorrhage

S B Tatter1, R M Crowell, C S Ogilvy

  • 1Neurosurgical Service, Massachusetts General Hospital, Boston, USA.

Neurosurgery
|July 1, 1995
PubMed
Summary

Microaneurysms are identified as a significant cause of subarachnoid hemorrhage (SAH) when initial angiograms are negative. These small vascular lesions, often too small for clipping, may represent an early form of saccular aneurysms.

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Area of Science:

  • Neurosurgery
  • Vascular Neurology
  • Radiology

Background:

  • Subarachnoid hemorrhage (SAH) with negative angiograms presents a diagnostic challenge.
  • Identifying the source of bleeding is crucial for effective patient management and prognosis.

Purpose of the Study:

  • To investigate the causes of bleeding in patients with angiogram-negative SAH.
  • To determine the role of microaneurysms in nonperimesencephalic angiogram-negative SAH.
  • To propose a management protocol for angiogram-negative SAH.

Main Methods:

  • Retrospective review of 40 patients with angiogram-negative SAH admitted between 1989 and 1993.
  • Surgical exploration in 9 selected patients to identify the source of hemorrhage.
  • Analysis of lesion characteristics, including size and type (aneurysm vs. microaneurysm).

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Main Results:

  • Surgical exploration identified arterial sources in 7 of 9 patients.
  • Identified lesions included complex artery lesions, middle cerebral artery lesions, and aneurysms.
  • Four lesions were microaneurysms, too small for surgical clipping; two of these patients experienced recurrent SAH.
  • No source was found in one patient with perimesencephalic SAH.

Conclusions:

  • Microaneurysms are a likely source for a substantial proportion of nonperimesencephalic angiogram-negative SAH.
  • Microaneurysms may represent an early stage of saccular aneurysm formation.
  • A management protocol based on CT scan blood distribution is proposed for angiogram-negative SAH.