| Evaluation of patients with spontaneous subarachnoid hemorrhage and negative angiography. | |
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MedLine Citation:
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PMID: 18162892 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: The evaluation of patients with subarachnoid hemorrhage (SAH) with negative initial catheter-based angiography is a diagnostic challenge. Better diagnostic strategies based on hemorrhage patterns are needed. METHODS: We retrospectively investigated the yield of focused history taking, magnetic resonance imaging of the brain and cervical spine, follow-up vascular imaging, laboratory investigations, and craniotomy for vessel exploration in 100 patients with SAH and negative initial catheter-based angiography. RESULTS: The most common distribution of hemorrhage was in a "classic" aneurysmal pattern filling the basal cisterns or posterior fossa (44 patients). A cause was determined in 13 patients (13%), the most common of which was aneurysm (7 patients). Repeat angiography was the most useful diagnostic modality, detecting seven lesions. The yield of the second angiogram was best in patients with a classic hemorrhage pattern (10%) and worse in patients with a negative computed tomographic scan and positive lumbar puncture (0%). The most common reason that a lesion was not detected on initial angiography was aneurysmal thrombosis (five patients). Magnetic resonance imaging of the brain and cervical spine detected one cervical ependymoma. Factors that may contribute to SAH, such as antiplatelet agent use and drug use, were found in 13 patients (13%). Adjunctive laboratory studies alerted practitioners to modifiable risk factors. CONCLUSION: These data suggest useful modifications to current diagnostic paradigms for patients with angiographically negative spontaneous SAH. |
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Authors:
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Andrew S Little; Mark Garrett; Rasha Germain; Nabeel Farhataziz; Felipe C Albuquerque; Cameron G McDougall; Joseph M Zabramski; Peter Nakaji; Robert F Spetzler |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Neurosurgery Volume: 61 ISSN: 1524-4040 ISO Abbreviation: Neurosurgery Publication Date: 2007 Dec |
Date Detail:
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Created Date: 2007-12-28 Completed Date: 2008-02-12 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7802914 Medline TA: Neurosurgery Country: United States |
Other Details:
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Languages: eng Pagination: 1139-50; discussion 1150-1 Citation Subset: IM |
Affiliation:
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Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Cerebral Angiography
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methods* Evaluation Studies as Topic* Follow-Up Studies Humans Magnetic Resonance Imaging Retrospective Studies Spinal Puncture / methods Subarachnoid Hemorrhage / classification, diagnosis*, etiology Tomography, X-Ray Computed / methods |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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