Subarachnoid hemorrhage and negative angiography: clinical course and long-term follow-up

Abstract

The aim of this study was to investigate the long-term natural history of nontraumatic angiogram-negative subarachnoid hemorrhage with typical pretruncal (P-SAH) and diffuse (D-SAH) pattern of hemorrhage. A retrospective review of 102 patients who experienced angiographically negative SAH at our institution was undertaken (11.6% of 882 spontaneous SAH). Follow-ups were obtained at 7.9 to 16 years. In the D-SAH group, 11 patients (13.9%) out of 79 had an aneurysm, and four (5.1%) had rebleeding episodes. In the P-SAH group, the second angiography was negative in all of the 23 cases, and no rebleeding episodes were recorded. The long-term follow-up confirms that P-SAH is a benign disease. A second angiography could not be necessary. D-SAH is probably due to an aneurysm that thrombose early after the bleeding. At short-term follow-up, the sack could frequently recanalize and rebleed, whereas a late follow-up shows that rebleeding is very rare.

Pattern Not Volume of Bleeding Predicts Angiographic Vasospasm in Nonaneurysmal Subarachnoid Hemorrhage

“…5,11,12 The higher risk seen in those with diffuse bleeding was still somewhat lower than that seen in aneurysmal SAH and was not associated with infarction. 2 This could be accounted for by the fact that none of even the diffuse nonaneurysmal patients had Hijdra sum scores ≥23, a threshold above which vasospasm was especially frequent in a recent study of aneurysmal SAH. 7 Most prior studies have assumed that the higher risk of vasospasm in those with diffuse bleeding was mediated by differences in blood burden.…”

“…1,2 Of these nonaneurysmal (idiopathic) patients, those with a perimesencephalic pattern of bleeding (PM-SAH) have a favorable prognosis, 3 whereas those with diffuse bleeding may have worse outcomes. [4][5][6] Although predictors of vascular lesions on subsequent evaluation have been studied, less is known about which patients are at risk for vasospasm and delayed cerebral ischemia (DCI) and may benefit from closer neurological monitoring.…”

Cerebral Angiographic Findings in Non-Traumatic Intracranial Hemorrhage: A Single Center Experience in the West of Iran

“…Causes suggested for inducing false negative angiography may include technical errors such as incomplete angiographic views, presence of vasospasm (especially on the 3rd to 14th day of hemorrhage), presence of hematoma mass-effect, existence of thrombosis in the neck of aneurysms and injection of hyperosmolar contrast [20][21][22][23][24][25][26][27]. According to most reports by other researchers, the maximum number of cases with non-traumatic intracranial hemorrhage were detected in age range of 50-59 years old [11,14,15,19,28]. Increased age has been recognized as a risk factor of hemorrhage; however, extreme old age is protective, decreasing the risk of hemorrhage [12,16,19,22,29].…”

“…The most common place of intracranial aneurysms is the circle of Willis and its immediate branches [11][12][13]. The location and the size of the aneurysms are the important factors influencing management and prognosis of patients [14,15]. The main aim of our study was to evaluate the demographic characteristics of 143 patients with non-traumatic intracranial hemorrhage, their angiographic results and correlation of CT scan findings and angiography of patients, investigating the etiologies and their angiographic presentations and discerning the anatomical distribution of cerebral aneurysms and areriovenous malformations in the Kermanshah.…”

Increasing numbers of nonaneurysmal subarachnoid hemorrhage in the last 15 years: antithrombotic medication as reason and prognostic factor?

“…Meanwhile, the observation of Fisher Grade 3 bleeding patterns increased from 15% (1999-2001) to 26% (2011-2013). In patients suffering from NASAH, favorable outcomes were significantly associated with the SAH pattern on initial CT. 8,25 A Fisher Grade 3 bleeding pattern represented a Table 3) and death (OR 3.0) compared with a NPM non-Fisher Grade 3 bleeding pattern, as described earlier. 13,16,25 A comparison between PM-and NPM-SAH revealed a trend towards an unfavorable outcome for NPM-SAH (p = 0.09), which supports recent data.…”