Meta-analysis of recent literature on utility of follow-up imaging in isolated perimesencephalic hemorrhage

Geng, Bertie; Wu, Xiao; Brackett, Alexandria; Malhotra, Ajay

doi:10.1016/j.clineuro.2019.03.006

Cited by 9 publications

(8 citation statements)

References 37 publications

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“…Over the past decade, high-resolution CTA has become increasingly convenient and has allowed intracranial aneurysms to be diagnosed with a high sensitivity and specificity ( 23 , 24 ). In recent meta-analyses of the role of CTA in PNSAH performed by Kalra et al ( 25 ) in 2015 that included 40 studies with 1031 PNSAHs and Geng et al ( 26 ) in 2019 that included 13 studies with 588 PNSAHs, the outcomes showed that an initial negative CTA was adequate in excluding aneurysms in PNSAH, which suggested modern high-resolution CTA is an acceptable replacement for DSA to rule out aneurysms in PNSAH ( 12 , 27 , 28 ).…”

Section: Definition and Variantmentioning

confidence: 99%

Current status of perimesencephalic non-aneurysmal subarachnoid hemorrhage

Hou

2022

Front. Neurol.

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Perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSAH) is a distinctive disease, representing SAH centered in perimesencephalic cisterns, with negative angiography findings. In recent years, the number of patients with PNSAH has increased significantly; however, the knowledge of PNSAH is insufficient. Therefore, we performed a review of the literature from a PubMed search and recounted our understanding of PNSAH. In this review, we summarized that current high-resolution computed tomography angiography is an acceptable replacement for digital subtraction angiography to rule out aneurysms in PNSAH with strict criteria. The current hypothesis about the etiology of PNSAH is that there is deep vein rupture from aberrant venous anatomy and increased intracranial venous pressure. PNSAH is associated with mild symptoms and lower rates of hydrocephalus and symptomatic vasospasm. For PNSAH, conservative treatment has been the mainstream treatment. PNSAH has a benign clinical course and an excellent prognosis; in long-term follow-up, re-bleeding and death were uncommon.

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Section: Definition and Variantmentioning

confidence: 99%

Current status of perimesencephalic non-aneurysmal subarachnoid hemorrhage

Hou

2022

Front. Neurol.

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“…9 Only few recommend a control DSA for pm SAH because the prevalence of intracranial aneurysms in pm SAH is low and DSA as the gold standard for the evaluation of a vascular lesion is also associated with complications as it is an invasive procedure. 3,[10][11][12][13] Beyond that, the pm SAH is often associated with a "benign" outcome, that is, the course of the pm SAH is often described with a lower clinical severity and a lower probability of complications. In contrast, the npm bleeding type is often considered similar to the aneurysmal SAH in terms of complications and outcome.…”

Section: Introductionmentioning

confidence: 99%

Subarachnoid Hemorrhage with Negative Initial Digital Subtraction Angiography: Subsequent Detection of Aneurysms and Complication Rates of Repeated Angiography

Nützel

Brandt

Rampp

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

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Background The data on handling of spontaneous, nontraumatic subarachnoid hemorrhage (SAH) with negative initial digital subtraction angiography (DSA) are still inconclusive. The intention of this study was to evaluate the requirement of repeat DSA in patients with negative initial DSA and to compare the clinical outcomes of these cases. Methods In a retrospective study, we reviewed patients with SAH and negative initial DSA treated in our department from January 2006 until December 2017. The patients were divided according to an established radiographic classification into perimesencephalic (pm) and nonperimesencephalic (npm) SAH. An interventional neuroradiologist and a neurosurgeon reviewed all DSA scans. Results In all, 52 patients with negative initial DSA, comprising 36 (69.2%) patients with pm and 16 (30.8%) patients with npm bleeding pattern, were included. All patients underwent a second and 23 of these patients underwent a third DSA. In these 23 patients, subarachnoid blood distribution in the initial computed tomography (CT) scan was suspicious for the presence of aneurysm. In total, two aneurysms were detected during the second DSA (diagnostic yield: 3.85%). Both were in the pm group (diagnostic yield: 5.6%). The second repeat DSA did not show any causative vascular lesion. Complications after the DSA occurred in only 2 of 127 patients (1.6%). The rate of complications concerning vasospasm (pm 52.8%, npm 56.3%), hydrocephalus (pm 47.2%, npm 50%), and the need for temporary or permanent shunt (pm 44.4%, npm 50%) was similar in both groups and there was no statistically significant difference. Conclusion Repeat DSA after negative initial DSA in pm SAH had a diagnostic yield of 5.6%. However, a second repeat DSA cannot be recommended in case of SAH with initial negative DSA. The pm SAH should not be underrated concerning the occurrence of complications and cared with a high level of surveillance.

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“…1 In spite of being the gold standard, DSA has the drawback of being operator and interpretation dependent, and aneurysms may be missed even on biplane DSA. 4 DSA may miss an aneurysm due to copious cisternal blood obscuring the aneurysm, vasospasm, thrombosis, small size of the aneurysm, or simply due to a technically inadequate examination. A complete four vessels cerebral angiogram with appropriate views performed by an experienced and competent surgeon/radiologist is mandatory in all doubtful cases of SAH.…”

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confidence: 99%

“…Available data on the yield of repeat angiography is limited, and there is an ongoing debate on the utility of repeated angiographic imaging. 4 The yield of repeat angiogram in PM-SAH has been uniformly poor. In a 2014 published meta-analysis of 1,031 patients with angionegative PM-SAH repeat angiogram detected aneurysms only in eight patients.…”

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confidence: 99%