Repeat cerebral pan-angiography in subarachnoid hemorrhage of unknown etiology.

@article{Gilbert1990RepeatCP,
  title={Repeat cerebral pan-angiography in subarachnoid hemorrhage of unknown etiology.},
  author={J W Gilbert and C Lee and Bryan Young},
  journal={Surgical neurology},
  year={1990},
  volume={33 1},
  pages={
          19-21
        }
}

The negative angiogram in subarachnoid haemorrhage

The overall incidence of negative cerebral panangiography in acute nontraumatic subarachnoid haemorrhage (SAH) was 31% (92/295); patients with perimesencephalic SAH fared particularly well; none developed complications during their hospital stay and repeat angiograms never revealed an underlying aneurysm.

Subarachnoid Hemorrhage with a Cerebral Aneurysm not Recognized at Conventional Angiography: A Retrospective Study

Whenever the DSA is negative in a patient strongly suspected of an aneurysmal SAH, the three above-mentioned causes should be considered and repeat DSA in the proper clinical setting is recommended.

Subarachnoid hemorrhage: utility of cerebral catheter angiogram in patients with abnormal and normal CT

In patients with acute nontraumatic SAH and negative cerebral catheter angiograms, CT studies showed perimesencephalic blood in 10 and were normal in 8 and MR angiography may be sufficient to evaluate the major intracranial arteries.

Subarachnoid Hemorrhage Without Detectable Aneurysm: A Review of the Causes

The prognosis and management of patients in whom no aneurysm is found on the initial angiogram depends on the pattern of hemorrhage on theInitial CT scan.

Presentation and management of patients with initial negative 4-vessel cerebral angiography in subarachnoid hemorrhage.

Repeat-cerebral angiography confirmed the source of hemorrhage in 3 patients and 3D-Angio-CT, and MR-angiography (MRA) in 1/5 patients were complementary non-invasive methods to diagnose aneurysms on repeated examinations.

Diagnostic yield of repeat catheter angiography in patients with catheter and computed tomography angiography negative subarachnoid hemorrhage.

BACKGROUND The yield of repeat catheter angiography in patients with subarachnoid hemorrhage (SAH) who have negative initial catheter and computed tomography (CT) angiograms is not well understood.

Comparison between perimesencephalic nonaneurysmal subarachnoid hemorrhage and subarachnoid hemorrhage caused by posterior circulation aneurysms.

This study supports the impression that there is no completely sensitive and specific CT pattern for a nonaneurysmal SAH and believes that digital subtraction angiography continues to be the gold standard for the diagnosis of cerebral aneurysms and should be performed even in patients who have the characteristic perimesencephalic SAH pattern on admission CT scans.

CT Patterns and Long-Term Outcome in Patients with an Aneurysmal Type of Subarachnoid Hemorrhage and Repeatedly Negative Angiograms

In contrast to patients with perimesencephalic hemorrhage who have an uneventful clinical course and an excellent outcome, patients with three negative angiograms and an aneurysmal pattern of hemorrhage are still at some risk of vascular complications and poor outcome.
...

References

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Spontaneous subarachnoid hemorrhage and negative cerebral panangiography. Review of 140 cases.

The distribution of blood, predominantly around the basal cisterns, suggests leakage from ventriculostriate and thalamoperforating vessels as the cause of SAH, and closer study of these vessels is suggested.

[Ruptured cerebral aneurysms not diagnosed by the initial cerebral angiography. Clinical and radiological study].

Between September 1971 and December 1982, 623 patients were admitted for treatment of cerebral aneurysms, and there were 10 whose initial panangiography showed negative findings for bleeding, which were subsequently revealed by repeat angiography in 8 patients and by autopsy in 2.

Subarachnoid hemorrhage of unknown cause.

After the institution of computed tomography (CT), 814 cases of spontaneous subarachnoid hemorrhage (SAH) were treated during a period of 6 years and 9 months (April 1978 through December 1984), and 31 cases were diagnosed as cases of SAH of unknown cause.

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

Among 6,638 cases reported to the Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage were 477 cases in which the cause of hemorrhage could not be determined after carotid and

The value of repeat pan-angiography in cases of unexplained subarachnoid hemorrhage.

Four-vessel angiography was repeated in 56 patients with confirmed subarachnoid hemorrhage in whom the initial investigation was negative and only one aneurysm was demonstrated, suggesting that to repeat pan-angiography is seldom justified unless further bleeding episodes occur.

Prognosis in subarachnoid hemorrhage of unknown etiology.

Thirty-two patients with subarachnoid hemorrhage of unknown etiology were followed for periods from 1 to 6 1/2 years and one possible early and no late episode of rebleeding.

Normal cerebral arteriography in patients with spontaneous subarachnoid hemorrhage

Improvements in neuroradiologic techniques, such as femoral catheterization, magnification angiography, oblique and basal projections, and subtraction most probably contribute to the improved yield of normal cerebral arteriograms.

The natural history of aneurysms and arteriovenous malformations.

Rptured aneurysms have their highest rate of rebleeding on Day 1, and at least 50% will rebleed during the 6 months after the first hemorrhage; the rate drops to at least 3% a year after that, the same rate as seen in anterior and posterior communicating artery aneurYSms treated by anterior cerebral artery clipping and carotid ligation.

Complications of cerebral angiography: prospective assessment of risk.

Although patients with a recent stroke or frequent transient ischemic attacks had a higher incidence of serious neurologic complications, this increase was not statistically significant for this sample.

Femoral catheter techniques in cerebral angiography--an analysis of 422 examinations.

This technique should be used more widely in selected cases to obtain studies of higher quality, and major advantages include multivessel cerebral angiograms via a femoral catheter, selective examination of vertebral, internal and external carotid arteries and rapid and easy application on infants and children.