Benign subarachnoid haemorrhage (subarachnoid haemorrhage of unknown aetiology)

Jain, Varsha; Hedge, T.; Easwaran, Ramakrishna; Das, B. S.; Reddy, G. N. Narayana

doi:10.1007/bf01402290

Cited by 20 publications

(12 citation statements)

References 16 publications

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“…It is also known to occur in Asian children suffering from various internal or infectious diseases [66]. Associated intraventricular haemon'hage is rare [24] and most patients present in a good clinical grade -only 4.7% of patients in the series of Jain et al were admitted in grade IV according to Hunt and Hess and none in grade V [35]. This is in contrast to our study with 18.8% poor grade patients on admission.…”

Section: Discussioncontrasting

confidence: 84%

“…In other studies no control angiography was performed after SAH of unknown origin [13,16,19,24,35], or only a subgroup of patients underwent control angiography [37,59], or the vertebral arteries were not included on angiography in a large part of the population studied [58]. Juul et al report a rate of false negative angiograms of 5-11% [37].…”

Section: Discussionmentioning

confidence: 94%

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Cerebral vasospasm after subarachnoid haemorrhage of unknown aetiology: A clinical and transcranial Doppler study

Schaller¹,

Raueiser²,

Rohde³

et al. 1996

Acta neurochir

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Sixteen patients (6 women, 10 men; mean age: 52.5 years) suffering from spontaneous subarachnoid haemorrhage (SAH) of unknown origin underwent a protocol of initial and then weekly computed tomography (CT), initial four-vessel digital subtraction angiography (DSA) and at least one control pancerebral DSA. Fourteen patients had magnetic resonance imaging before undergoing first control DSA. All patients had calcium-antagonists (Nimodipine) via a central venous catheter, were kept on the neurosurgical intensive care unit and followed daily with transcranial Doppler ultrasonography (TCD). One patient (6.3%) developed moderate and 5 (31.1%) developed severe cerebral vasospasm as documented with TCD and exhibited deterioration of their level of consciousness. These 6 patients were treated with induced hypertension, hypervolaemia and haemodilution. Their blood flow velocities were elevated for a mean of 8 (5-17) days with a peak after 12.5 (9-17) days following SAH. No complications due to treatment were noted. One patient of the non-vasospastic group died of pulmonary embolism, another patient had an ischaemic incident during angiography, which has led to permanent disability. On follow-up 2-24 months after SAH 14 patients had returned to their premorbid state. It is concluded that patients suffering from SAH of unknown origin should undergo repeated angiographic investigation and subsequent daily monitoring of their neurologic status including daily TCD recordings so that haemodynamic treatment can be established in the event of cerebral vasospasm, which may occur in up to one third of these patients.

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Section: Discussioncontrasting

confidence: 84%

Section: Discussionmentioning

confidence: 94%

Cerebral vasospasm after subarachnoid haemorrhage of unknown aetiology: A clinical and transcranial Doppler study

Schaller¹,

Raueiser²,

Rohde³

et al. 1996

Acta neurochir

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“…3,9,12,14,23 In a series of 71 patients with angiographically negative SAH, Canhão et al 3 reported that 3% of patients rebled, 4% developed delayed cerebral ischemia, and 3% had hydrocephalus that required placement of a shunt. Duong and coworkers 4 described outcome at hospital discharge in a series of 87 patients with angiographically negative SAH.…”

Section: 24mentioning

confidence: 99%

Spontaneous subarachnoid hemorrhage of unknown origin: hospital course and long-term clinical and angiographic follow-up

Elhadi

Zabramski

Almefty

et al. 2015

JNS

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N oNtraumatic subarachnoid hemorrhage (SAH) accounts for approximately 5% of all stroke admissions in the United States each year, with an estimated incidence of 10-15 cases per 100,000 population. 1,16 Aneurysms and other vascular abnormalities are well-documented causes of nontraumatic SAH; however, in 10%-20% of cases, no underlying vascular etiology is found, and the source of hemorrhage remains unknown. 5,15,18,26,28 Patients with an SAH of unknown etiology typically have a benign hospital course and are discharged to home in good condition.While the clinical outcome of these patients has been abbreviatioNs AVM = arteriovenous malformation; BRAT = Barrow Ruptured Aneurysm Trial; CTA = CT angiography; CTN = CT negative; DSA = digital subtraction angiography; EVD = external ventricular drain; GOS = Glasgow Outcome Scale; HH = Hunt and Hess; IQR = interquartile range; IVH = intraventricular hemorrhage; LOS = length of hospital stay; MRA = MR angiography; mRS = modified Rankin Scale; PMH = perimesencephalic hemorrhage; SAH = subarachnoid hemorrhage; VP = ventriculoperitoneal. obJect Hemorrhagic origin is unidentifiable in 10%-20% of patients presenting with spontaneous subarachnoid hemorrhage (SAH). While the patients in such cases do well clinically, there is a lack of long-term angiographic followup. The authors of the present study evaluated the long-term clinical and angiographic follow-up of a patient cohort with SAH of unknown origin that had been enrolled in the Barrow Ruptured Aneurysm Trial (BRAT). methods The BRAT database was searched for patients with SAH of unknown origin despite having undergone two or more angiographic studies as well as MRI of the brain and cervical spine. Follow-up was available at 6 months and 1 and 3 years after treatment. Analysis included demographic details, clinical outcome (Glasgow Outcome Scale, modified Rankin Scale [mRS]), and repeat vascular imaging. results Subarachnoid hemorrhage of unknown etiology was identified in 57 (11.9%) of the 472 patients enrolled in the BRAT study between March 2003 and January 2007. The mean age for this group was 51 years, and 40 members (70%) of the group were female. Sixteen of 56 patients (28.6%) required placement of an external ventricular drain for hydrocephalus, and 4 of these subsequently required a ventriculoperitoneal shunt. Delayed cerebral ischemia occurred in 4 patients (7%), leading to stroke in one of them. There were no rebleeding events. Eleven patients were lost to followup, and one patient died of unrelated causes. At the 3-year follow-up, 4 (9.1%) of 44 patients had a poor outcome (mRS > 2), and neurovascular imaging, which was available in 33 patients, was negative. coNclusioNs Hydrocephalus and delayed cerebral ischemia, while infrequent, do occur in SAH of unknown origin. Long-term neurological outcomes are generally good. A thorough evaluation to rule out an etiology of hemorrhage is necessary; however, imaging beyond 6 weeks from ictus has little utility, and rebleeding is unexpected.

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“…However, many groups report non-specific symptoms such as headache, neuropsychological deficits or depressive symptoms in up to 62% of patients 14–16. The rebleeding rate is approximately 5% (0–10%)7 8 15–18 and the risk of death in non-aneurysmal bleeding has been estimated to be 0–15%2 4 7 8 12 13 15 17 18 Greebe and Rinkel15 concluded that patients with an angiographic negative perimesencephalic pattern of SAH have a normal life expectancy but Hawkins et al 17 found the cumulative proportional survival after 22 years to be 69% compared with an expected survival of 89% in patients with SAH of unknown aetiology.…”

Section: Introductionmentioning

confidence: 99%

Long term outcome after subarachnoid haemorrhage of unknown aetiology

Pyysalo

Niskakangas

Keski-Nisula

et al. 2011

Journal of Neurology, Neurosurgery & Psychiatry

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Background and purposeThe aim of this study was to assess the long term outcome after non-aneurysmal subarachnoid haemorrhage (SAH).Methods1154 patients with SAH were treated in our hospital between 1989 and 1999. From this patient population, 97 patients had a non-aneurysmal SAH. All hospital records and death certificates were studied and 33 patients were examined by MRI and MR angiography more than 9 years (mean 12 years) after the initial bleeding.ResultsThe cohort consisted of 97 patients. Mean follow-up time was 9 years (range 0–19). During the follow-up period, 13 patients (13%) died. Four (4%) died from the initial bleeding less than 5 weeks after the initial haemorrhage. There was no delayed mortality due to SAH or subsequent bleedings. MR angiography revealed no new findings in 33 surviving patients.ConclusionsExcess mortality during the first year after SAH was higher than 4%, and remained thereafter comparable with the general population. There were no rebleedings and MR imaging did not reveal any vascular pathology that could explain the earlier SAH.

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Benign subarachnoid haemorrhage (subarachnoid haemorrhage of unknown aetiology)

Cited by 20 publications

References 16 publications

Cerebral vasospasm after subarachnoid haemorrhage of unknown aetiology: A clinical and transcranial Doppler study

Cerebral vasospasm after subarachnoid haemorrhage of unknown aetiology: A clinical and transcranial Doppler study

Spontaneous subarachnoid hemorrhage of unknown origin: hospital course and long-term clinical and angiographic follow-up

Long term outcome after subarachnoid haemorrhage of unknown aetiology

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