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Diagnosis of perimesencephalic nonaneurysmal subarachnoid hemorrhage with computed tomography.
MedLine Citation:
PMID:  17903834     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: In 4% to 31% of patients with acute subarachnoid hemorrhage (SAH), no underlying cause is identified. Blood is restricted to the perimesencephalic cisterns in about two thirds of these patients. These patients are identified as having perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSAH), a syndrome based on the interpretation of computed tomography (CT) findings on admission, with an excellent prognosis, far better than other patients with SAH with or without an aneurysm. However, the diagnosis is subject to interrater variability, and differentiation between PNSAH and ruptured supratentorial aneurysm by means of CT has not been investigated. Therefore we investigated the validity of prediction of PNSAH with CT scan. METHODS: A total of 303 consecutive patients, admitted within 72 hours after the initial bleeding with symptoms and signs of spontaneous SAH, which was confirmed by CT or spectrophotometric analysis of the cerebrospinal fluid (CSF) in whom either a selective 4-vessel angiogram (n = 293) or postmortem examination (n = 10) was performed, were studied. RESULTS: We found an interrater agreement for the diagnosis perimesencephalic nonaneurysmal subarachnoid hemorrhage of 93% and a kappa value of 0.65. Sensitivity was 30% for observer 1 and 46% for observer 2. The positive predictive value was 73% for observer 1 and 76% for observer 2. Among those diagnosed as having PNSAH, we found vertebrobasilar artery aneurysms in 19% (both raters) and internal carotid artery aneurysms in 5% (observer 1) and 8% (observer 2). CONCLUSION: We conclude that PNSAH can be distinguished on CT in the majority of patients; however, the angiographical management in PNSAH should not differ from other SAHs.
Authors:
E J van Dijk; R M Hupperts; M van der Jagt; H W Bijvoet; D Hasan
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association     Volume:  10     ISSN:  1532-8511     ISO Abbreviation:  J Stroke Cerebrovasc Dis     Publication Date:    2001 Nov-Dec
Date Detail:
Created Date:  2007-10-01     Completed Date:  2008-04-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9111633     Medline TA:  J Stroke Cerebrovasc Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  247-51     Citation Subset:  -    
Affiliation:
Department of Neurology, Academisch Ziekenhuis Maastricht, Maastricht, The Netherlands.
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