| The Management Strategy of Spontaneous Subarachnoid Hemorrhage in Patients with Initial Negative Angiogram. |
| Young Seok Park, Yong Bae Kim, Seung Kon Huh, Kyu Chang Lee |
| Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea. sk522@yumc.yonsei.ac.kr |
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| 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. |
| Key Words:
Subarachnoid hemorrhage; CT findings; Cerebral angiogram; False negative |
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