Abstract
Our purpose was to review the incidence of negative cerebral panangiography in acute nontraumatic subarachnoid haemorrhage (SAH); to document the amount and distribution of subarachnoid blood on CT and determine its relationship to findings on repeat angiography; and to study the outcome of these patients from the time of presentation to hospital discharge. From 1983 to 1992, 295 patients underwent cerebral angiography for acute SAH at our institution. The CT, angiographic and MRI findings and clinical course of patients with initially negative angiograms were reviewed retrospectively. The overall incidence of negative cerebral panangiography was 31% (92/295). An aneurysm was disclosed on a second angiogram in 4 cases, and on a third angiogram in 1, giving a total false negative rate of 5%. In 55% of cases, only a small amount of SAH was present on CT. The distribution of the subarachnoid blood was nonspecific and resembled the pattern seen in aneurysmal SAH. Ninetyfour percent, of the patients presented in Hunt-Hess grades I and II. The complications of conservative treatment were few: a rebleed rate of 4%, delayed cerebral ischemia in 4%, cerebral infarcts in 8% and hydrocephalus requiring shunting in 3%. On discharge, 93% of patients had recovered completely and the others were left with moderate disability. There were two deaths related to massive rebleeding. Patients with perimesencephalic SAH (35%) fared particularly well; none developed complications during their hospital stay and repeat angiograms never revealed an underlying aneurysm. In such cases, further angiographic investigations do not seem warranted.
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Suzuki S, Kayama T, Sakurai Y, Ogawa A, Suzuki J (1987) Subarachnoid haemorrhage of unknown cause. Neurosurgery, 21:310–313
Levy LF (1960) Subarachnoid haemorrhage without arteriographic vascular abnormality. J Neurosurg 17:252–258
Kassell NF, Torner JC, Jane JA, Haley EC, Adams HP (1990) The international cooperative study of the timing of aneurvsm surgery, part 2. Surgical results. J Neurosurg 73:37–47
Nishioka H, Torner JC, Graf CJ, Kassell NF, Sahs AL, Goettler LC (1984) Cooperative study of intracranial aneurysms and subarachnoid haemorrhage: a long-term prognostic study. III. Subarachnoid haemorrhage of undetermined etiology. Arch Neurol 41: 1147–1151
Hijdra A, Brouwers PJAM, Vermeulen M, Gijn J van (1990) Grading the amount of blood on computed tomograms after subarachnoid haemorrhage. Stroke 21:1156–1161
Barlow P (1985) Incidence of delayed cerebral ischaemia following subarachnoid haemorrhage of unknown cause. J Neurol Neurosurg Psychiatry 48:132–136
Brismar J, Sundbarg G (1985) Subarachnoid haemorrhage of unknown origin: prognosis and prognostic factors. J Neurosurg 63:349–354
Giombini S, Bruzzne MG, Pluchino F (1988) Subarachnoid haemorrhage of unexplained cause. Neurosurgery 22: 313–316
Gomez PA, Lobato RD, Rivas JJ, Cabrera A, Sarabia R, Castro S, Castañeda M, Canizal JM (1989) Subarachnoid haemorrhage of unknown aetiology. Acta Neurochir (Wien) 101:35–41
Loiseau H, Castel JP, Stoiber HP (1989) Aspects cliniques neuroradiologiques et évolutifs du syndrome d'hémorrhagie méningée bénigne idiopathique (hémorrhagie méningée sans cause reconnue). Étude rétrospective de 65 patients. Neurochirurgie 35:222–228
Sakai N, Yamada H, Ando T, Nishimura Y (1985) Prevention of rebleeding after operation for subarachnoid haemorrhage of unknown cause. Neurosurgery 17:942–946
Shepard RH (1984) Prognosis of spontaneous (non-traumatic) subarachnoid haemorrhage of unknown cause. Lancet I:777–778
Cioffi F, Pasqualin A, Cavazzani P, Da Pian R (1989) Subarachnoid haemorrhage of unknown origin: clinical and tomographical aspects. Acta Neurochir (Wien) 97:31–39
Oder W, Kollegger H, Zeiler K, Dal-Bianco P, Wessely P, Deecke L (1991) Subarachnoid haemorrhage of unknown etiology: early prognostic factors for long-term functional capacity. J Neurosurg 74:601–605
Rinkel GJE, Wijdicks EFM, Vermeulen M, Ramos LMP, Tanghe HLJ, Hasan D, Meiners LC, Gijn J van (1991) Nonaneurysmal perimesencephalic subarachnoid haemorrhage: CT and MR patterns that differ from aneurysmal rupture. AJNR 12:829–834
Forster DMC, Steiner L, Hakanson S, Bergvall U (1978) The value of repeat pan-angiography in cases of unexplained subarachnoid haemorrhage. J Neurosurg 48:712–716
Iwanaga H, Wakai S, Ochiai C, Narita J, Inoh S, Nagai M (1990) Ruptured cerebral aneurysms missed by initial angiographic study. Neurosurgery 27:45–51
Gilbert JW, Lee C, Young B (1990) Repeat cerebral pan-angiography in subarachnoid haemorrhage of unknown etiology. Surg Neurol 33:19–21
Curnes JP, Shogry MEC, Clark DC, Elsner HJ (1993) MR angiographic demonstration of an intracranial aneurysm not seen on conventional angiography. AJNR 14:971–973
Renowden SA, Molyneux AJ, Anslow P, Byrne JV (1994) The value of MRI in angiogram-negative intracranial haemorrhage. Neuroradiology 36:422–425
Hayward RD (1977) Subarachnoid haemorrhage of unknown aetiology. A clinical and radiological study of 51 cases. J Neurol Neurosurg Psychiatry 40:926–931
Alexander MSM, Dias PS, Uttley D (1986) Spontaneous subarachnoid haemorrhage and negative cerebral pan-angiography. Review of 140 cases. J Neurosurg 64:537–542
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Duong, H., Melancon, D., Tampieri, D. et al. The negative angiogram in subarachnoid haemorrhage. Neuroradiology 38, 15–19 (1996). https://doi.org/10.1007/BF00593209
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DOI: https://doi.org/10.1007/BF00593209