Clinical relevance of negative initial angiogram in spontaneous subarachnoid hemorrhage

Moscovici, Samuel; Fraifeld, Shifra; Ramirez-de-Noriega, Fernando; Rosenthal, Guy; Leker, Ronen R.; Itshayek, Eyal; Cohen, José E.

doi:10.1179/1743132812y.0000000147

Cited by 18 publications

(2 citation statements)

References 35 publications

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“…1). Of these, 19 were prospective [1, 2, 9, 10, 20, 21, 32, 38, 39, 41–44, 47, 48, 50, 51, 53, 54], 37 were retrospective [4, 6–8, 12–15, 17, 24, 25, 27, 28, 30, 31, 34–36, 40, 57, 58, 61, 63, 66–69, 71–76, 78, 80–82] and two studies [11, 52] had both prospective and retrospective data (Table e-1). Quality assessment results are summarised in Fig.…”

Section: Resultsmentioning

confidence: 99%

Subarachnoid haemorrhage with negative initial neurovascular imaging: a systematic review and meta-analysis

et al. 2019

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BackgroundIn patients with spontaneous subarachnoid haemorrhage (SAH), a vascular cause for the bleed is not always found on initial investigations. This study aimed to systematically evaluate the delayed investigation strategies and clinical outcomes in these cases, often described as “non-aneurysmal” SAH (naSAH).MethodsA systematic review was performed in concordance with the PRISMA checklist. Pooled proportions of primary outcome measures were estimated using a random-effects model.ResultsFifty-eight studies were included (4473 patients). The cohort was split into perimesencephalic naSAH (PnaSAH) (49.9%), non-PnaSAH (44.7%) and radiologically negative SAH identified on lumbar puncture (5.4%). The commonest initial vascular imaging modality was digital subtraction angiography. A vascular abnormality was identified during delayed investigation in 3.9% [95% CI 1.9–6.6]. There was no uniform strategy for the timing or modality of delayed investigations. The pooled proportion of a favourable modified Rankin scale outcome (0–2) at 3–6 months following diagnosis was 92.0% [95% CI 86.0–96.5]. Complications included re-bleeding (3.1% [95% CI 1.5–5.2]), hydrocephalus (16.0% [95% CI 11.2–21.4]), vasospasm (9.6% [95% CI 6.5–13.3]) and seizure (3.5% [95% CI 1.7–5.8]). Stratified by bleeding pattern, we demonstrate a higher rate of delayed diagnoses (13.6% [95% CI 7.4–21.3]), lower proportion of favourable functional outcome (87.2% [95% CI 80.1–92.9]) and higher risk of complications for non-PnaSAH patients.ConclusionThis study highlights the heterogeneity in delayed investigations and outcomes for patients with naSAH, which may be influenced by the initial pattern of bleeding. Further multi-centre prospective studies are required to clarify optimal tailored management strategies for this heterogeneous group of patients.Electronic supplementary materialThe online version of this article (10.1007/s00701-019-04025-w) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Subarachnoid haemorrhage with negative initial neurovascular imaging: a systematic review and meta-analysis

et al. 2019

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“… 12 13 Rinkel et al attributed this pattern of SAH to a ruptured posterior circulation aneurysm in up to 5% patients, 6 although rates as low as 1.3% have been reported. 14 According to the series by Kallmes et al in 1996, ruptured posterior circulation aneurysm can present with PM-SAH in up to 12.4% patients. 15 The etiology of nonaneurysmal SAH remains unknown, but it is presumed to have a venous origin in most cases like a tear in the basal vein of Rosenthal or one of its tributaries, anterior longitudinal pontine, or interpeduncular and posterior communicating veins.…”

Section: Discussionmentioning

confidence: 98%

The Yield of Repeat Angiography in Angiography-Negative Spontaneous Subarachnoid Hemorrhage

Yeole

Nagesh

Shukla

et al. 2020

JNRP

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Objective Despite the technological advancement in imaging, digital subtraction angiography (DSA) remains gold standard imaging modality for spontaneous subarachnoid hemorrhage (SAH). But even after DSA, around 15% of SAH remains elusive for the cause of the bleed. This is an institutional review to solve the mystery, “when is second DSA really indicated?” Methods In a retrospective review from January 2015 to December 2017, we evaluated cases of spontaneous SAH with initial negative DSA with repeat DSA after 6 weeks to rule out vascular abnormality. The spontaneous SAH was confirmed on noncontrast computed tomography (NCCT) and divided into two groups of perimesencephalic SAH (PM-SAH) or nonperimesencephalic SAH (nPM-SAH). The outcome was assessed by a modified Rankin’s score (mRS) at 6 months postictus. Result During the study period, we had 119 cases of initial negative DSA and 98 cases (82.3%) underwent repeat DSA after 6 weeks interval. A total of 53 cases (54.1%) had PM-SAH and 45 cases (45.9%) had nPM-SAH. Repeat DSA after 6 weeks showed no vascular abnormality in 53 cases of PM-SAH and in 2 (4.4%) out of 45 cases of nPM-SAH. At 6 months postictus, all cases of PM-SAH and 93% of nPM-SAH had mRS of 0. Conclusion We recommend, a repeat DSA is definitely not required in PM-SAH, but it should be done for all cases of nPM-SAH, before labeling them as nonaneurysmal SAH. Although the overall outcome for nonaneurysmal spontaneous SAH is better than aneurysmal SAH, nPM-SAH has poorer eventual outcome compared to PM-SAH.

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Usefulness of 3D High-resolution Vessel Wall MRI in Diffuse Nonaneurysmal SAH Patients

et al. 2021

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Clinical relevance of negative initial angiogram in spontaneous subarachnoid hemorrhage

Cited by 18 publications

References 35 publications

Subarachnoid haemorrhage with negative initial neurovascular imaging: a systematic review and meta-analysis

Subarachnoid haemorrhage with negative initial neurovascular imaging: a systematic review and meta-analysis

The Yield of Repeat Angiography in Angiography-Negative Spontaneous Subarachnoid Hemorrhage

Usefulness of 3D High-resolution Vessel Wall MRI in Diffuse Nonaneurysmal SAH Patients

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