E-219 Utility of repeat angiography in aneurysmal-pattern angiographically negative subarachnoid hemorrhage

ABSTRACT:In recent years there has been a tendency to abandon repeat cerebral angiography in patients with subarachnoid hemorrhage (SAH) if the initial angiogram is normal because prognosis is said to be excellent. Our experience does not support such a conclusion. We report our experiences in 25 patients with SAH, who had a normal initial angiogram. Aneurysms were seen in five of 20 cases when angiography was repeated. On subsequent review of the initial angiograms, the aneurysm was apparent in four of the five cases. When these four initial angiograms were shown to a second observer, unaware of the results of the second study, three of the four aneurysms were correctly identified. We suggest that if, under strong clinical suspicion of SAH, the angiogram is reported as normal the study should be reviewed by a second neuro-radiologist before proceeding to repeat angiography.

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Subarachnoid hemorrhage of unknown etiology at an initial angiography. Shall we need repeat angiography?

Nosotchu ◽

10.3995/jstroke.13.192 ◽

1991 ◽

Vol 13 (3) ◽

pp. 192-197 ◽

Cited By ~ 1

Author(s):

Masami Shimoda ◽

Shinri Oda ◽

Osamu Sato ◽

Ryuichi Tsugane

Keyword(s):

Subarachnoid Hemorrhage ◽

Unknown Etiology ◽

Repeat Angiography

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The Yield of Repeat Angiography in Angiography-Negative Spontaneous Subarachnoid Hemorrhage

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0040-1714313 ◽

2020 ◽

Vol 11 (04) ◽

pp. 565-572 ◽

Cited By ~ 1

Author(s):

Ujwal Yeole ◽

Madhusudhan Nagesh ◽

Dhaval Shukla ◽

Aravind H. R. ◽

Prabhuraj A. R.

Keyword(s):

Subarachnoid Hemorrhage ◽

Imaging Modality ◽

Technological Advancement ◽

Vascular Abnormality ◽

Institutional Review ◽

Repeat Angiography ◽

Noncontrast Computed Tomography ◽

Spontaneous Subarachnoid Hemorrhage ◽

Eventual Outcome ◽

Better Than

Abstract Objective Despite the technological advancement in imaging, digital subtraction angiography (DSA) remains gold standard imaging modality for spontaneous subarachnoid hemorrhage (SAH). But even after DSA, around 15% of SAH remains elusive for the cause of the bleed. This is an institutional review to solve the mystery, “when is second DSA really indicated?” Methods In a retrospective review from January 2015 to December 2017, we evaluated cases of spontaneous SAH with initial negative DSA with repeat DSA after 6 weeks to rule out vascular abnormality. The spontaneous SAH was confirmed on noncontrast computed tomography (NCCT) and divided into two groups of perimesencephalic SAH (PM-SAH) or nonperimesencephalic SAH (nPM-SAH). The outcome was assessed by a modified Rankin’s score (mRS) at 6 months postictus. Results During the study period, we had 119 cases of initial negative DSA and 98 cases (82.3%) underwent repeat DSA after 6 weeks interval. A total of 53 cases (54.1%) had PM-SAH and 45 cases (45.9%) had nPM-SAH. Repeat DSA after 6 weeks showed no vascular abnormality in 53 cases of PM-SAH and in 2 (4.4%) out of 45 cases of nPM-SAH. At 6 months postictus, all cases of PM-SAH and 93% of nPM-SAH had mRS of 0. Conclusion We recommend, a repeat DSA is definitely not required in PM-SAH, but it should be done for all cases of nPM-SAH, before labeling them as nonaneurysmal SAH. Although the overall outcome for nonaneurysmal spontaneous SAH is better than aneurysmal SAH, nPM-SAH has poorer eventual outcome compared to PM-SAH.

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Cerebral perivascular nerves in subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/jns.1986.65.4.0531 ◽

1986 ◽

Vol 65 (4) ◽

pp. 531-539 ◽

Cited By ~ 40

Author(s):

Hideaki Hara ◽

Michael Nosko ◽

Bryce Weir

Keyword(s):

Subarachnoid Hemorrhage ◽

Blood Clot ◽

Autologous Blood ◽

Nerve Fibers ◽

Content Type ◽

Arterial Blood ◽

Mild Reduction ◽

Perivascular Nerves ◽

Basilar Arteries ◽

Repeat Angiography

✓ The authors have studied the changes induced by subarachnoid hemorrhage (SAH) in the density and distribution of cerebral perivascular nerves in monkeys and rats. The SAH was induced in monkeys by placement of an autologous blood clot after opening the basal cisterns over the arteries of the circle of Willis on one side. In the rat study, SAH was induced by injection of autologous arterial blood into the cisterna magna. The nerves examined were adrenergic nerves, acetylcholinesterase (AChE)-containing nerves, vasoactive intestinal polypeptide (VIP)-like immunoreactive nerves, and substance P-like immunoreactive nerves. In the monkey study, all animals underwent baseline cerebral angiography, then had repeat angiography just before sacrifice on Day 2, 7, 28, or 70 after SAH. Two sham-operated monkeys underwent the surgical procedure without clot placement and were sacrificed on postoperative Day 7, after repeat angiography. Clot placement in monkeys reduced staining of all middle cerebral artery (MCA) perivascular nerves for between 2 and 28 days post-SAH. The number of stained nerve fibers of MCA's on the non-operated side was slightly reduced on Days 2 and 7 after SAH. Sham-operated monkeys showed a mild reduction of staining in all nerves, but only on the operated side. Cerebral vasospasm was observed on all angiograms taken on Days 2 and 7 following SAH. No vasospasm was found in normal or sham-operated monkeys. The disappearance of nerve staining without associated vasospasm was found on the operated side of the sham-operated monkeys and on the clot side of the animal sacrificed on Day 28 after SAH. Rats sacrificed on Days 2 and 7 post-SAH showed reduction in adrenergic and VIP-like immunoreactive staining around basilar arteries, while nerves containing AChE were not affected. Saline-injected rats exhibited no change in the appearance of perivascular innervation. These results suggest that SAH as well as surgical manipulation of the vessel wall caused a reduction of the studied substances in cerebral perivascular nerves. This reduction in immunoreactive staining of perivascular nerves did not correlate with the development of angiographic vasospasm after SAH.

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Ruptured Dissecting Aneurysm of the Vertebral Artery Revealed by Repeat Angiography

Neurosurgery ◽

10.1227/00006123-198808000-00017 ◽

1988 ◽

Vol 23 (2) ◽

pp. 225-227 ◽

Cited By ~ 24

Author(s):

Yasushi Ito ◽

Ryoji Ishii ◽

Yasuo Suzuki ◽

Masahisa Kikuoka ◽

Kazuhiro Hirano ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Vertebral Artery ◽

Dissecting Aneurysm ◽

Repeat Angiography ◽

The Right ◽

Angiographic Change

ABSTRACT A case of subarachnoid hemorrhage caused by the rupture of a dissecting aneurysm of the vertebral artery is reported. The initial angiogram was normal, and repeat angiography carried out 12 days later revealed a dissecting aneurysm of the right vertebral artery. This angiographic change seems to be due to the progression of minimal dissection that was not found at the time of first angiogram.

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Subarachnoid Hemorrhage with Normal Cerebral Angiography: A Prospective Study on Sellar Abnormalities and Pituitary Function

Neurosurgery ◽

10.1227/00006123-198612000-00018 ◽

1986 ◽

Vol 19 (6) ◽

pp. 1012-1015 ◽

Cited By ~ 9

Author(s):

Per Bjerre ◽

VidebÆk Henrik ◽

Lindholm JÖrgen

Keyword(s):

Subarachnoid Hemorrhage ◽

Hormone Secretion ◽

Growth Hormone Secretion ◽

Empty Sella ◽

Pituitary Dysfunction ◽

Hemorrhagic Necrosis ◽

Typical History ◽

Repeat Angiography ◽

A Prospective Study

Abstract Ten consecutive patients with subarachnoid hemorrhage (SAH) of unknown cause were examined for sellar abnormalities and pituitary dysfunction. The diagnosis of SAH rested on a typical history and the demonstration of blood in the cerebrospinal fluid (computed tomography (CT), lumbar puncture). Initial CT and four-vessel angiography were performed in all patients, and five had repeat angiography. Endocrinological assessment was done after the initial angiography, and abnormal findings from this first study were reassessed 3 months later. The follow-up study included a high resolution CT scan of the sellar region. One patient had panhypopituitarism. Insufficient growth hormone secretion alone or combined with a low plasma concentration of estradiol or testosterone was found in another seven patients. The sella was ballooned or enlarged in three patients, and four patients had at follow-up a partly empty sella. A spontaneous development of a partly empty sella from an adenoma with suprasellar extension was observed in the patient with panhypopituitarism. This patient had experienced pituitary apoplexy with resulting SAH. Based on sellar enlargement, an empty sella, and pituitary dysfunction, this pathogenesis was suggested in another three patients. Our findings suggest that hemorrhagic necrosis in a pituitary adenoma may be an important cause of SAH with normal angiography.

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Nontraumatic subarachnoid hemorrhage: value of repeat angiography.

Radiology ◽

10.1148/radiology.202.3.9051036 ◽

1997 ◽

Vol 202 (3) ◽

pp. 798-800 ◽

Cited By ~ 27

Author(s):

R du Mesnil de Rochemont ◽

W Heindel ◽

C Wesselmann ◽

K Krüger ◽

H Lanfermann ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Repeat Angiography

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Development of new intracranial saccular aneurysms

Acta chirurgica iugoslavica ◽

10.2298/aci0802047r ◽

2008 ◽

Vol 55 (2) ◽

pp. 47-49

Author(s):

D.V. Radulovic ◽

G.M. Tasic ◽

I.M. Nikolic ◽

M.B. Jokovic ◽

N.R. Repac ◽

...

Keyword(s):

Risk Factors ◽

Subarachnoid Hemorrhage ◽

Angiographic Study ◽

Cerebral Vessel ◽

Postoperative Course ◽

Repeat Angiography ◽

Saccular Aneurysms

Newly formed aneurysms developing from a cerebral vessel which had appeared to be normal in a previous angiographic study are very rare. Four cases of angiographically documented newly developed saccular aneurysms are described in this report. In all four patients, the new aneurysms were symptomatic, causing subarachnoid hemorrhage (SAH). Repeat angiography, performed after the second SAH, revealed new aneurysms that were not demonstrated on initial angiograms after the first SAH. They were clipped with good postoperative course. Our observations and literature data suggest that some patients with SAH need further neuroradiological followup. The presence of the risk factors and age of the patient should be taken into consideration.

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