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The negative angiogram in subarachnoid haemorrhage
H Duong1, D Melançon, D Tampieri
1Department of Radiology, Montreal General Hospital, Quebec, Canada.
Neuroradiology
|January 1, 1996
Summary
A significant percentage of acute non-traumatic subarachnoid hemorrhage (SAH) cases initially show negative cerebral angiography. Repeat angiography is rarely positive, suggesting conservative management is often appropriate, especially for perimesencephalic SAH.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Acute non-traumatic subarachnoid hemorrhage (SAH) presents diagnostic challenges.
- Cerebral angiography is a key diagnostic tool, but initial results can be negative.
Purpose of the Study:
- To determine the incidence of negative cerebral panangiography in acute non-traumatic SAH.
- To correlate CT findings with repeat angiography results.
- To evaluate patient outcomes with conservative management.
Main Methods:
- Retrospective review of 295 patients with acute SAH (1983-1992).
- Analysis of CT, angiographic, and MRI findings.
- Assessment of clinical course and outcomes from presentation to discharge.
Main Results:
- Overall incidence of negative cerebral panangiography was 31%.
- Aneurysm found on repeat angiography in only 5% of initially negative cases.
- 55% of cases had small amounts of SAH on CT; distribution was nonspecific.
- 94% presented in Hunt-Hess grades I-II with few complications (e.g., 4% rebleed rate).
- 93% recovered completely; perimesencephalic SAH patients fared well with no complications or aneurysm detection.
Conclusions:
- A significant proportion of acute SAH patients have negative initial cerebral angiograms.
- Repeat angiography has a low yield for detecting aneurysms in these cases.
- Conservative management is often safe and effective, particularly for perimesencephalic SAH, where further angiography may not be necessary.