Subarachnoid hemorrhage of unknown origin. Longterm prognosis

Abstract

Patients suffering subarachnoid hemorrhage in whom angiography does not initially show vascular malformation and CT scan rules out an intracranial tumor, have, reportedly, a good prognosis with a rate of recurrent hemorrhage of about 2-10% within a follow-up time of up to 15 years. Most authors denied indication for control angiography. In order to study the benefit of control angiography performed after 4-6 weeks, four-hundred eighty-three patients with SAH but without ICH were reveiwed, and the longterm clinical course of 98 patients with SAH of unknown origin treated in our department between 1976 and 1988 was investigated. Among 183 patients who underwent control angiography, a second angiography showed an aneurysm in 143. The third angiography was positive in a further 18 patients. Recurrent SAH occurred early only in patients who had undergone only one angiography. One patient died from intracerebral hemorrhage of unknown origin two years following SAH. These data support the need for control angiography in cases of SAH.

Diagnostic value of magnetic resonance imaging in perimesencephalic and nonperimesencephalic subarachnoid hemorrhage of unknown origin

“…1,3,4,14 However, according to different studies, a bleeding source is not identified on the first DS angiogram in up to 27% of cases. 8,11,12,13,16 The reason could be initial local vasospasm or occlusion of the ruptured aneurysm due to blood clots. 12 Authors of a number of studies have proved an initial nonfilling aneurysm on a second DS angiogram.…”

“…12 Authors of a number of studies have proved an initial nonfilling aneurysm on a second DS angiogram. 4,12,13,17 Jung et al 11 postulate that about 60% of all cases of SAH with negative DS angiograms can be attributed to PM SAH. Given our results of 26.3% patients with PM SAH, the incidence of 60% seems very high.…”

“…Because aneurysmal hemorrhage occasionally produces PM SAH (especially basilar tip aneurysms) as well as non-PM SAH, a second-look DS angiogram remains necessary. 10,13,15 At this point we underline the retrospective nature of our work. Future prospective studies with distinct test conditions are necessary to verify our observations.…”

Spontaneous subarachnoid haemorrhage with negative initial angiography: A review of 143 cases

“…Although the risks of morbidity and mortality associated with aneurysmal SAH are high, prognosis is better for SAH due to causes other than aneurysm rupture. [5][6][7][8][9] Perimesencephalic SAH as described by Van Gijn et al is representative of non-aneurysmal SAH, is known to have almost no risk of rebleeding, and is associated with good recovery. 10 Accordingly, when the cause of the haemorrhage cannot be found on the first cerebral angiogram it is important to distinguish between causal factors that are the most clinically serious; that is, whether a cerebral aneurysm exists but cannot be found, or whether the haemorrhage is a result of other unknown causes.…”