Clinical study
Subarachnoid haemorrhage of unknown cause: Clinical, neuroradiological and evolutive aspects

https://doi.org/10.1016/S0967-5868(98)90062-5Get rights and content

Abstract

The clinical and radiological data of 52 patients with subarachnoid haemorrhage (SAH) and a negative panangiography were analysed with an average follow-up period of 3.8 years. Of these 52 patients, only one (1.9%) was subsequently found to have an aneurysm. Second angiography proved to be inconclusive in all 24 cases where it was performed. Of the 51 ‘true’ non-aneurysmal SAH, 80% were in a good clinical grade on admission and 12% developed cerebral ischaemia. The mortality rate following SAH was 4%. There was one rebleeding. At follow-up examination, 87% of the patients had made a good recovery and 6% were left disabled due to SAH. Four patients with an aneurysmal pattern of SAH required a permanent shunt. All of the 22 patients with a perimesencephalic SAH were in a good neurological condition upon admission; one of them developed an angiography-induced transient cerebral ischaemia and another one suffered from a fatal rebleeding. None of the 21 survivors was disabled at follow-up examination. The clinical course of patients with SAH of unknown cause, especially those with a perimesencephalic pattern of haemorrhage, is good. Repeated angiography in this latter group is not useful. In the aneurysmal pattern SAH group, repeat angiography is advised only if there is strong computed tomographic (CT) scan suspicion of an aneurysm.

References (45)

  • C Béguelin et al.

    Subarachnoid hemorrhage with normal cerebral panangiography

    Neurosurgery

    (1983)
  • VK Jain et al.

    Benign subarachnoid haemorrhage (subarachnoid haemorrhage of unknown aetiology)

    Acta Neurochir (Wien)

    (1987)
  • S Kawamura et al.

    Clinical and long-term follow-up study in patients with spontaneous subarachnoid haemorrhage of unknown aetiology

    Acta Neurochir (Wien)

    (1990)
  • H Loiseau et al.

    Aspects cliniques, neuroradiologiques et évolutifs du syndrome d' “hémorragie méningée bénigne idiopathique” (hémorragie méningée sans cause reconnue)

  • A Ruelle et al.

    Long-term prognosis of subarachnoid hemorrhages of unknown etiology

    J Neurol

    (1985)
  • GJE Rinkel et al.

    The clinical course of perimesencephalic nonaneurysmal subarachnoid hemorrhage

    Ann Neurol

    (1991)
  • J Van Gijn et al.

    Perimesencephalic hemorrhage: a nonaneurysmal and benign form of subarachnoid hemorrhage

    Neurology

    (1985)
  • WE Hunt et al.

    Surgical risk as related to time of intervention in the repair of intracranial aneurysms

    J Neurosurg

    (1968)
  • CM Fisher et al.

    Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning

    Neurosurgery

    (1980)
  • H Nishioka et al.

    Cooperative study of intracranial aneurysms and subarachnoid hemorrhage: a long-term prognostic study. III: subarachnoid hemorrhage of undetermined etiology

    Arch Neurol

    (1984)
  • H Iwanaga et al.

    Ruptured cerebral aneurysms missed by initial angiographic study

    Neurosurgery

    (1990)
  • H Duong et al.

    The negative angiogram in subarachnoid haemorrhage

    Neuroradiology

    (1996)
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      Importantly, 24.1% of patients in our study had SAH with no detectable vascular abnormalities. This is higher than the 10%–15% range that is traditionally quoted as the proportion of angiogram-negative SAH.4,9-11,23 This implies that 1 in 4 patients with confirmed SAH could potentially have an excellent prognosis compared with the previously held proportion of 1 in 8 patients.

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