Management of Spontaneous Subarachnoid Hemorrhage Patients with Negative Initial Digital Subtraction Angiogram Findings: Conservative or Aggressive?

Abstract

Background. The ideal management of SAH patients with negative initial DSA findings remains unresolved. Objective. (i) To present risk factors, clinical courses, and outcomes in different types of SAH patients with negative DSA findings; (ii) to explore the differences of basal vein between aSAH patients and NASAH patients; and (iii) to evaluate the value of repeated DSA for these patients. Methods. All SAH patients with negative initial DSA findings between 2013 and 2015 in our hospital were enrolled and were further categorized as perimesencephalic SAH (PMN-SAH) or nonperimesencephalic SAH (nPMN-SAH). Risk factors, clinical courses, outcomes, and the basal vein drainage patterns were compared. Results. A total of 137 patients were enrolled in the present study. The PMN-SAH group had better GOS and mRS values at 1-year follow-up. Moreover, the nPMN-SAH group had a higher rate of complications. The basal vein drainage pattern showed significant difference when comparing each of the NASAH subtypes with aSAH groups. There was a significant higher rate of a responsible aneurysm in nPMN-SAH group upon repeated DSA. Conclusions. SAH patients with negative initial DSA findings had benign clinical courses and outcomes. Repeated DSA studies are strongly advised for patients with the nPMN-SAH pattern.

Nontraumatic Nonaneurysmal Subarachnoid Hemorrhage: Risk Factors, Complications, and Clinical Outcomes

“…The patients were divided into the PM-SAH (n = 45 patients) and the nPM-SAH groups (n = 33) based on the bleeding pattern on the initial CT scan. 9,11 All patients underwent cranial and spinal MRI for the recognition of possible underlying causes. If a vascular lesion was suspected, additional spinal DSA was performed.…”

“…The outcomes were evaluated using the Glasgow outcome scale (GOS) at the time of discharge. 5,9 We considered GOS = 4 to 5 as a favorable outcome and GOS = 1 to 3 as unfavorable outcomes. 12…”

“…3,8 Based on the distribution pattern of the SAH, these cases are usually divided into two subgroups, perimesencephalic (PM-SAH) and nonperimesencephalic subarachnoid hemorrhage (nPM-SAH). 4,9 PM-SAH is usually associated with lower complication rates and more favorable outcomes. 3,9 However, there is a controversy about the clinical outcomes and complications of patients with nPM-SAH.…”

“…4,9 PM-SAH is usually associated with lower complication rates and more favorable outcomes. 3,9 However, there is a controversy about the clinical outcomes and complications of patients with nPM-SAH. 10 Meanwhile, recent studies recommend that the management of the nPM-SAH group should be more rigorous, keeping in mind its more severe clinical courses and outcomes.…”

“…10 Meanwhile, recent studies recommend that the management of the nPM-SAH group should be more rigorous, keeping in mind its more severe clinical courses and outcomes. 3,9 The present study aimed to investigate the risk factors, complications, and clinical outcomes of patients with NNSAH who were admitted to our center between April 2009 and April 2019.…”