| Comparison between perimesencephalic nonaneurysmal subarachnoid hemorrhage and subarachnoid hemorrhage caused by posterior circulation aneurysms. | |
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MedLine Citation:
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PMID: 12650424 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECT: Some authors have questioned the need to perform cerebral angiography in patients presenting with a benign clinical picture and a perimesencephalic pattern of subarachnoid hemorrhage (SAH) on initial computerized tomography (CT) scans, because the low probability of finding an aneurysm does not justify exposing patients to the risks of angiography. It has been stated, however, that ruptured posterior circulation aneurysms may present with a perimesencephalic SAH pattern in up to 10% of cases. The aim of the present study was twofold: to define the frequency of the perimesencephalic SAH pattern in the setting of ruptured posterior fossa aneurysms, and to determine whether this clinical syndrome and pattern of bleeding could be reliably and definitely distinguished from that of aneurysmal SAH. METHODS: Twenty-eight patients with ruptured posterior circulation aneurysms and 44 with nonaneurysmal perimesencephalic SAH were selected from a series of 408 consecutive patients with spontaneous SAH admitted to the authors' institution. The admission unenhanced CT scans were evaluated by a neuroradiologist in a blinded fashion and classified as revealing a perimesencephalic SAH or a nonperimesencephalic pattern of bleeding. Of the 28 patients with posterior circulation aneurysms, five whose grade was I according to the World Federation of Neurosurgical Societies scale were classified as having a perimesencephalic SAH pattern on the initial CT scan. The data show that the likelihood of finding an aneurysm on angiographic studies obtained in a patient with a perimesencephalic SAH pattern is 8.9%. Conversely, ruptured aneurysms of the posterior circulation present with an early perimesencephalic SAH pattern in 16.6% of cases. CONCLUSIONS: This study supports the impression that there is no completely sensitive and specific CT pattern for a nonaneurysmal SAH. In addition, the authors believe that there is no specific clinical syndrome that can differentiate patients who have a perimesencephalic SAH pattern caused by an aneurysm from those without aneurysms. Digital subtraction angiography continues to be the gold standard for the diagnosis of cerebral aneurysms and should be performed even in patients who have the characteristic perimesencephalic SAH pattern on admission CT scans. |
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Authors:
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Jose F Alén; Alfonso Lagares; Ramiro D Lobato; Pedro A Gómez; Juan J Rivas; Ana Ramos |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: Journal of neurosurgery Volume: 98 ISSN: 0022-3085 ISO Abbreviation: J. Neurosurg. Publication Date: 2003 Mar |
Date Detail:
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Created Date: 2003-03-24 Completed Date: 2003-04-02 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0253357 Medline TA: J Neurosurg Country: United States |
Other Details:
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Languages: eng Pagination: 529-35 Citation Subset: AIM; IM |
Affiliation:
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Department of Neurosurgery and Division of Neuroradiology, Hospital "12 de Octubre", Facultad de Medicina, Universidad Complutense, Madrid, Spain. jfalen@teleline.es |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Aneurysm, Ruptured / complications* Cerebral Angiography* Diagnosis, Differential Female Humans Incidence Intracranial Aneurysm / complications* Male Middle Aged Single-Blind Method Subarachnoid Hemorrhage / epidemiology, etiology*, radiography* Tomography, X-Ray Computed* |
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