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Clinical Differences Between Angiographically Negative, Diffuse Subarachnoid Hemorrhage and Perimesencephalic Subarachnoid Hemorrhage

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Abstract

Objective

To identify prognostic factors for vasospasm, hydrocephalus, and clinical outcomes in patients with angiographically negative, non-traumatic, diffuse subarachnoid hemorrhage (d-SAH).

Methods

Retrospective review of patients who experienced angiographically negative SAH at our institution over the past 6 years was undertaken. The patients were stratified based on grade at presentation, severity, and pattern of SAH on initial non-enhanced, computed tomography (CT) of the head into perimesencephalic and diffuse subtypes. The patients were further differentiated based on the development of vasospasm, hydrocephalus and required treatments, and clinical outcomes. Patients were excluded if a causative lesion was discovered subsequently.

Results

Ninety-four patients with angiographically negative SAH were identified. A total of 31 patients were considered to have the perimesencephalic (p-SAH) subtype, while 63 patients fit criteria for the diffuse (d-SAH) subtype. Compared to the p-SAH subtype, those patients with d-SAH subtype had significantly higher risk for complications related to SAH with an increased incidence of hydrocephalus (50.8% vs. 9.6%), requirement for external ventricular drainage (41% vs. 9.6%), and for the hydrocephalus requiring eventual permanent cerebrospinal fluid diversion (20.6% vs. 0%). Patients with d-SAH were also at an increased risk for symptomatic vasospasm (28.6% vs. 9.6%). Ultimately, only 76% of d-SAH patients achieved complete recovery and independent living, compared to 96.7% of p-SAH patients.

Conclusion

The angiographically negative d-SAH pattern is associated with worse presentations and outcome. These patients are at increased risk for vasospasm and hydrocephalus requiring aggressive treatment and should therefore be cared for with a higher level of surveillance.

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References

  1. Alen J, Lagares A, Lobato R, Gomez P, Rivas J, Ramos A. Comparison between perimesencephalic nonaneurysmal subarachnoid hemorrhage and subarachnoid hemorrhage caused by posterior circulation aneurysms. J Neurosurg. 2003;98:529–35.

    Article  PubMed  Google Scholar 

  2. Alexander MS, Dias PS, Uttley D. Spontaneous subarachnoid hemorrhage and negative cerebral panangiography. Review of 140 cases. J Neurosurg. 1986;64:537–42.

    Article  PubMed  CAS  Google Scholar 

  3. Andaluz N, Zuccarello M. Yield of further diagnostic work-up of cryptogenic subarachnoid hemorrhage based on bleeding patterns on computed tomographic scans. Neurosurgery. 2008;62(5):1040–7.

    Article  PubMed  Google Scholar 

  4. Ausman J. Perimesencephalic nonaneurysmal subarachnoid hemorrhage: what is it? What are we missing? Surg Neurol. 2002;57:211. doi:10.1016/S0090-3019(02)00634-1.

    Article  PubMed  Google Scholar 

  5. Canhao P, Ferro JM, Pinto AN, Melo TP, Campos JG. Perimesencephalic and nonperimesencephalic subarachnoid haemorrhages with negative angiograms. Acta Neurochir (Wien). 1995;132:14–9. doi:10.1007/BF01404842.

    Article  CAS  Google Scholar 

  6. Congia S, Carta S, Coraddu M. Subarachnoid hemorrhage of unknown origin. A 44 cases study. Acta Neurol (Napoli). 1994;16:177–83.

    CAS  Google Scholar 

  7. du Mesnil de Rochemont R, Heindel W, Wesselmann C, Kruger K, Lanfermann H, Ernestus RI, et al. Nontraumatic subarachnoid hemorrhage: value of repeat angiography. Radiology. 1997;202:798–800.

    PubMed  Google Scholar 

  8. Duong H, Melancon D, Tampieri D, Ethier R. The negative angiogram in subarachnoid haemorrhage. Neuroradiology. 1996;38:15–9. doi:10.1007/BF00593209.

    Article  PubMed  CAS  Google Scholar 

  9. Flaherty ML, Haverbusch M, Kissela B, Kleindorfer D, Schneider A, Sekar P, et al. Perimesencephalic subarachnoid hemorrhage: incidence, risk factors, and outcome. J Stroke Cerebrovasc Dis. 2005;14:267–71. doi:10.1016/j.jstrokecerebrovasdis.2005.07.004.

    Article  PubMed  Google Scholar 

  10. Giombini S, Bruzzone MG, Pluchino F. Subarachnoid hemorrhage of unexplained cause. Neurosurgery. 1988;22:313–6. doi:10.1097/00006123-198802000-00006.

    Article  PubMed  CAS  Google Scholar 

  11. Goergen SK, Barrie D, Sacharias N, Waugh JR. Perimesencephalic subarachnoid haemorrhage: negative angiography and favourable prognosis. Australas Radiol. 1993;37:156–60. doi:10.1111/j.1440-1673.1993.tb00040.x.

    Article  PubMed  CAS  Google Scholar 

  12. Ildan F, Tuna M, Erman T, Gocer AI, Cetinalp E. Prognosis and prognostic factors in nonaneurysmal perimesencephalic hemorrhage: a follow-up study in 29 patients. Surg Neurol. 2002;57:160–5. discussion 165–166.

    Article  PubMed  Google Scholar 

  13. Jung JY, Kim YB, Lee JW, Huh SK, Lee KC. Spontaneous subarachnoid haemorrhage with negative initial angiography: a review of 143 cases. J Clin Neurosci. 2006;13(10):1011–7.

    Article  PubMed  Google Scholar 

  14. Kleinpeter G, Lehr S. Characterization of risk factor differences in perimesencephalic subarachnoid hemorrhage. Minim Invasive Neurosurg. 2003;46:142–8. doi:10.1055/s-2003-40742.

    Article  PubMed  CAS  Google Scholar 

  15. Rinkel G, Wijdicks E, Vermeulen M, Hageman L, Tans J, van Gijn J. Outcome in perimesencephalic (nonaneurysmal) subarachnoid hemorrhage: a follow-up study in 37 patients. Neurology. 1990;40:1130–2.

    PubMed  CAS  Google Scholar 

  16. Rinkel GJ, Wijdicks EF, Hasan D, Kienstra GE, Franke CL, Hageman LM, et al. Outcome in patients with subarachnoid haemorrhage and negative angiography according to pattern of haemorrhage on computed tomography. Lancet. 1991;338:964–8. doi:10.1016/0140-6736(91)91836-J.

    Article  PubMed  CAS  Google Scholar 

  17. Rinkel GJ, Wijdicks EF, Vermeulen M, Hasan D, Brouwers PJ, van Gijn J. The clinical course of perimesencephalic nonaneurysmal subarachnoid hemorrhage. Ann Neurol. 1991;29:463–8. doi:10.1002/ana.410290503.

    Article  PubMed  CAS  Google Scholar 

  18. Tatter SB, Crowell RM, Ogilvy CS. Aneurysmal and microaneurysmal “angiogram-negative” subarachnoid hemorrhage. Neurosurgery. 1995;37:48–55. doi:10.1097/00006123-199507000-00007.

    Article  PubMed  CAS  Google Scholar 

  19. van der Schaaf IC, Velthuis BK, Gouw A, Rinkel GJ. Venous drainage in perimesencephalic hemorrhage. Stroke. 2004;35:1614–8. doi:10.1161/01.STR.0000131657.08655.ce.

    Article  PubMed  Google Scholar 

  20. van Gijn J, van Dongen KJ, Vermeulen M, Hijdra A. Perimesencephalic hemorrhage: a nonaneurysmal and benign form of subarachnoid hemorrhage. Neurology. 1985;35:493–7.

    PubMed  Google Scholar 

  21. Watanabe A, Hirano K, Kamada M, Imamura K, Ishii N, Sekihara Y, et al. Perimesencephalic nonaneurysmal subarachnoid haemorrhage and variations in the veins. Neuroradiology. 2002;44:319–25. doi:10.1007/s00234-001-0741-3.

    Article  PubMed  CAS  Google Scholar 

  22. Zentner J, Solymosi L, Lorenz M. Subarachnoid hemorrhage of unknown etiology. Neurol Res. 1996;18:220–6.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Emory University, Atlanta, GA, USA

    Ferdinand K. Hui & Y. Jonathan Zhang

  2. Division of Interventional Neuroradiology, Emory University, Atlanta, GA, USA

    Ferdinand K. Hui, C. Michael Cawley & Y. Jonathan Zhang

  3. Department of Neurosurgery, Naval Medical Center, 34800 Bob Wilson Drive, San Diego, CA, 92134, USA

    Luis M. Tumialán

  4. Department of Neurosurgery, Emory University, Atlanta, GA, USA

    Tomoko Tanaka, C. Michael Cawley & Y. Jonathan Zhang

  5. Cleveland Clinic Foundation, Cerebrovascular Institute, 9500 Euclid Avenue S80, Cleveland, OH, 44195, USA

    Ferdinand K. Hui

Authors
  1. Ferdinand K. Hui
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  2. Luis M. Tumialán
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  3. Tomoko Tanaka
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  4. C. Michael Cawley
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  5. Y. Jonathan Zhang
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Correspondence to Ferdinand K. Hui.

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Hui, F.K., Tumialán, L.M., Tanaka, T. et al. Clinical Differences Between Angiographically Negative, Diffuse Subarachnoid Hemorrhage and Perimesencephalic Subarachnoid Hemorrhage. Neurocrit Care 11, 64–70 (2009). https://doi.org/10.1007/s12028-009-9203-2

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  • DOI: https://doi.org/10.1007/s12028-009-9203-2

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