Clinical and digital subtraction angiographic (DSA) evaluation of patients of subarachnoid haemorrhage (SAH) in a tertiary level hospital

Abstract

The present study was undertaken to evaluate the morphological anatomy of cerebral vessels in patients of aneurysmal subarachnoid hemorrhage. The cross-sectional observational study was carried out in the Department of Neurology, Dhaka Medical College Hospital, Dhaka from January 2013 to June 2013. Adult patients of spontaneous subarachnoid haemorrhage (SAH), diagnosed clinically and confirmed by CT scan of the head were included in the study. However, patients who are not capable financially of undergoing Digital Subtraction Angiography (DSA), traumatic subarachnoid haemorrhage, intracerebral haemorrhage and patients taking antiplatelet and anticoagulant drugs and with comorbidities were excluded. A total of 30 subjects meeting the above eligibility criteria were selected consecutively from the study population. The present study demonstrated that 80% of the patients were 50 or younger than 50 years old (mean age 45.0 ± 9.4 years) with a male preponderance (60%). Sudden headache accompanied by vomiting was invariably complained by the patients at onset of Athe disease. On admission two-thirds (66.7%) of the patients were unconscious. 4 out of 30(16.65%) patients exhibited neurological deficit. Of the risk factors, hypertension and smoking demonstrated their significant presence (around 45%) among the patients studied. Based on Glasgow Coma Scale, 7(23.3%) patients out of 30 in the present study were in grade-v. Our data showed that the common site of aneurysm was anterior communication artery (36.7%) followed by middle cerebral artery (26.7%) and posterior communicating artery (23.3%). Saccular aneurysms formed the main bulk (93%) of the cases irrespective of anatomical distribution of aneurysm. In aneurysmal subarachnoid haemorrhage, aneurysms are mainly located in anterior communicating and middle cerebral arteries and of medium-sized. Majority are saccular type and narrow-necked.Bangladesh Med J. 2015 Sep; 44 (3): 125-129

Loss of Consciousness at Onset of Subarachnoid Hemorrhage as Marker of Short Term Outcome

“…In line with the findings of Hassan et al 11 Islam et al 12 and Linn et al 13 sudden headache and vomiting were the most frequent presenting symptom in this study. But vomiting is not a distinctive feature as almost half the patients with non-hemorrhagic thunderclap headache also report vomiting at onset.…”

“…Majority of patients were relatively older (45 to 65 years) which corresponds with similar studies conducted by Suarez et al 9 and Suwatcharangkoon et al 10 . Similar to this study, Hassan et al 11 and Islam et al 12 found higher incidence among male (60.0% & 59.8%).…”

“…The reported frequency of LOC as a presenting symptoms was much higher in this study than the report of Suwatcharangkoon et al 10 , Hassan et al 11 and Al-Shahi et al 14 . This is probably due to the difference in operational definitions among these studies.…”

Diagnostic Value of Low-Dose 256-Slice Spiral CT Angiography, MR Angiography, and 3D-DSA in Cerebral Aneurysms

“…At present, the three dimensional-digital subtraction angiography (3D-DSA) is the gold standard for diagnosis and evaluation of cerebral aneurysms. But it is an invasive examination with risks [1]. Other timely and safe clinical diagnostic tools still need to improve the prognosis of patients under emergent conditions.…”

Impact of Virtual Reality in Arterial Anatomy Detection and Surgical Planning in Patients with Unruptured Anterior Communicating Artery Aneurysms

“…3D-DSA reconstructions allow accurate assessment of aneurysm morphology and accurate demonstration of the anatomic relationship between the aneurysm and the ACoA complex [ 38 ]. However, DSA is a costly and time-consuming invasive examination, with a risk of complications [ 39 ]. Furthermore, in unilateral angiography only the ipsilateral A1 and A2 segments, without association with the bony skull base, are usually clearly demonstrated [ 38 ].…”