The Management Strategy of Spontaneous Subarachnoid Hemorrhage in Patients with Initial Negative Angiogram.
- Author:
Young Seok PARK
1
;
Yong Bae KIM
;
Seung Kon HUH
;
Kyu Chang LEE
Author Information
1. Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea. sk522@yumc.yonsei.ac.kr
- Publication Type:Original Article
- Keywords:
Subarachnoid hemorrhage;
CT findings;
Cerebral angiogram;
False negative
- MeSH:
Aneurysm;
Aneurysm, Ruptured;
Hematoma;
Humans;
Neurosurgery;
Retrospective Studies;
Spasm;
Spinal Puncture;
Subarachnoid Hemorrhage*
- From:Journal of Korean Neurosurgical Society
2003;34(5):433-439
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
OBJECTIVE: The aim of this retrospective clinical study is to provide a proper management strategy for patients who present spontaneous subarachnoid emorrhage(SAH) with negative initial angiogram by investigating the clinical features, long-term outcomes and radiologic characteristics. METHODS: One hundred and twenty-eight out of 2887 SAH patients who were admitted to neurosurgery department from 1986 to 2002 had negative initial angiogram. We classified the 128 patients into 3 groups(Group I: no evidence of SAH on CT but confirmed by lumbar puncture, Group II: perimesencephalic(PM) SAH pattern, Group III: non-perimesencephalic(NPM) SAH pattern), and reviewed the radiologic findings, the clinical features, the rebleeding rate, the long-term outcome, and the results of repeated angiogram. Factors related to the false negative initial angiogram were also reviewed. RESULTS: The patients were 9(7.0%) in Group l, 85(66.4%) in Group ll, and 34(26.6%) in Group lll. There was no difference in long-term clinical outcome. Ninety-two out of 128 patients underwent a repeated angiogram in which 18 patients were found to have ruptured aneurysms that were not detected on the initial angiogram(false negative rate: overall 19.6%, 1.8% in Group II, 50.0% in Group lll). Small size( < 6mm) aneurysms, spasms, hematomas, and anterior communicating aneurysms were the factors affecting false negative initial angiogram. CONCLUSION: In SAH patients with negative initial angiogram, espeacially those who had a non-perimesencephalic SAH pattern on initial CT findings, a repeated angiogram should be considered for identifying the hidden ruptured aneurysm.
