Subarachnoid Hemorrhage of Unknown Cause

Neurosurgery ◽  
1987 ◽  
Vol 21 (3) ◽  
pp. 310-313 ◽  
Author(s):  
Shinsuke Suzuki ◽  
Takamasa Kayama ◽  
Yoshiharu Sakurai ◽  
Akira Ogawa ◽  
Jiro Suzuki
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Unknown Etiology ◽  
Ruptured Aneurysms ◽  
Spontaneous Subarachnoid Hemorrhage

Abstract 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). In 9 (22.0%) of 41 patients whose cause of SAH was not determined by the first four-vessel study (cerebral panangiography), ruptured aneurysms were found by repeated four-vessel study. Thus, of 814 cases, only 32 (3.9%) were diagnosed as cases of unknown etiology at discharge. The 32 cases were monitored by follow-up examination for 5 to 67 months (median, 27.1 months) after onset. No recurrence of SAH was reported, and all patients were rehabilitated except 2 who suffered terminal carcinoma. A third follow-up four-vessel study was performed 8 to 44 months (median, 22.0 months) after the second study in 14 of the 16 patients with SAH initially demonstrated by CT. In 1 of these cases, an aneurysm found 9 months after the initial SAH was treated surgically. Ultimately, 31 cases (3.8%) were diagnosed as cases of SAH of unknown cause. This incidence is low when compared with those in previous reports. Because of the strict examination schedule including repeated angiography, the incidence is lower and the prognosis is relatively favorable.

scholarly journals Spontaneous subarachnoid hemorrhage of unknown origin: hospital course and long-term clinical and angiographic follow-up

2015 ◽  
Vol 122 (3) ◽  
pp. 663-670 ◽  
Author(s):  
Ali M. Elhadi ◽  
Joseph M. Zabramski ◽  
Kaith K. Almefty ◽  
George A. C. Mendes ◽  
Peter Nakaji ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
External Ventricular Drain ◽  
Delayed Cerebral Ischemia ◽  
Unknown Origin ◽  
Unknown Etiology ◽  
Neurological Outcomes ◽  
Spontaneous Subarachnoid Hemorrhage

OBJECT Hemorrhagic origin is unidentifiable in 10%–20% of patients presenting with spontaneous subarachnoid hemorrhage (SAH). While the patients in such cases do well clinically, there is a lack of long-term angiographic followup. The authors of the present study evaluated the long-term clinical and angiographic follow-up of a patient cohort with SAH of unknown origin that had been enrolled in the Barrow Ruptured Aneurysm Trial (BRAT). METHODS The BRAT database was searched for patients with SAH of unknown origin despite having undergone two or more angiographic studies as well as MRI of the brain and cervical spine. Follow-up was available at 6 months and 1 and 3 years after treatment. Analysis included demographic details, clinical outcome (Glasgow Outcome Scale, modified Rankin Scale [mRS]), and repeat vascular imaging. RESULTS Subarachnoid hemorrhage of unknown etiology was identified in 57 (11.9%) of the 472 patients enrolled in the BRAT study between March 2003 and January 2007. The mean age for this group was 51 years, and 40 members (70%) of the group were female. Sixteen of 56 patients (28.6%) required placement of an external ventricular drain for hydrocephalus, and 4 of these subsequently required a ventriculoperitoneal shunt. Delayed cerebral ischemia occurred in 4 patients (7%), leading to stroke in one of them. There were no rebleeding events. Eleven patients were lost to followup, and one patient died of unrelated causes. At the 3-year follow-up, 4 (9.1%) of 44 patients had a poor outcome (mRS > 2), and neurovascular imaging, which was available in 33 patients, was negative. CONCLUSIONS Hydrocephalus and delayed cerebral ischemia, while infrequent, do occur in SAH of unknown origin. Long-term neurological outcomes are generally good. A thorough evaluation to rule out an etiology of hemorrhage is necessary; however, imaging beyond 6 weeks from ictus has little utility, and rebleeding is unexpected.

Computed Tomography Angiography (CTA) Evaluation of Spontaneous Subarachnoid Hemorrhage

2020 ◽  
Vol 6 (2) ◽  
pp. 78-81
Author(s):  
Md Tauhidul Islam Chowdhury ◽  
Mohammad Shah Jahirul Hoque Chowdhury ◽  
Mohammad Sadekur Rahman Sarkar ◽  
KM Ahasan Ahmed ◽  
Md Nazmul Kabir ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Computed Tomography Angiography ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Multiple Aneurysm ◽  
Traumatic Subarachnoid Hemorrhage ◽  
One Year ◽  
Spontaneous Subarachnoid Hemorrhage

Background: In evaluation of non-traumatic subarachnoid hemorrhage CT angiography (CTA) has 97-98% sensitivity and near 100% specificity. Objective: This study was conducted to evaluate the CTA findings of CT positive non traumatic subarachnoid hemorrhage. Methodology: This is an observational cross sectional study performed in Neurology department of National Institute of Neurosciences and Hospital, Dhaka over one year period (January 2019 to December 2019). Total 87 CT positive subarachnoid hemorrhage cases were purposively included in this study. All CT positive patients underwent CTA of Cerebral vessels for further evaluation. The angiography were evaluated by competent neuro-radiologists blinded about the study. Result: Among 87 patients, 40.2% were male and 59.8% were female. The average age was 53.33±11.1 years. Among the studied patient the source of bleeding was found 78.16% aneurysmal and 21.84% non-aneurysmal. 85.30% patients had single aneurysm and 14.70% had multiple aneurysm. The highest number of patient had Acom aneurysm (41.17%) followed by MCA (22.05%), ICA (13.23%), ACA (7.35%) and vertebral artery (1.14%) in order of frequency. Among the multiple aneurysm group most of the patients had combination of Acom, MCA and ICA aneurysm. Conclusion: From this study, we can conclude that CTA can be used as the primary diagnostic tool in evaluation of spontaneous SAH. Journal of National Institute of Neurosciences Bangladesh, 2020;6(2): 78-81

Transsphenoidal Removal of Retroclival Chondroma with Pituitary Transposition Manifesting as Repeated Subarachnoid Hemorrhage: A Case Report

2019 ◽  
Vol 80 (03) ◽  
pp. 228-232
Author(s):  
Yoshikazu Ogawa ◽  
Kuniyasu Niizuma ◽  
Teiji Tominaga
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Residual Tumor ◽  
Good Prognosis ◽  
Growth Potential ◽  
Unknown Etiology ◽  
Large Tumor ◽  
Prepontine Cistern ◽  
Extended Transsphenoidal Approach ◽  
Short Period

Background Intracranial chondromas are extremely rare and represent only 0.2% of all intracranial primary neoplasms. The histologic appearance lacks nuclear atypism and mitoses, and it usually shows low growth potential, although these benign features do not necessarily imply a good prognosis. Case Description A 44-year-old man was referred to our institution with a subarachnoid hemorrhage (SAH). He had a history of SAH 5 years previously that was diagnosed as unknown etiology at another hospital. Head magnetic resonance imaging showed a large tumor located in the prepontine cistern and extending up to the interpeduncular cistern, and the tumor was irregularly enhanced with contrast medium. Retrospective analysis of the original computed tomography of 5 years earlier identified a small contrast enhancing defect behind the dorsum sellae. Tumor removal was planned to prevent repeated SAH and control the apparently growing tumor. An extended transsphenoidal approach was performed. The pituitary gland was dissected from the bottom of the sellar floor and transposed forward to the prechiasmatic cistern with preservation of the pituitary stalk and its blood supply, and subtotal removal of the tumor was achieved. Postoperative diabetes insipidus disappeared within a few days, and the patient was discharged without neurologic or endocrinologic deficits. Histologic examination established the diagnosis as chondroma without a sarcomatous component. Follow-up examination 3 months after surgery showed a re-enlargement of the residual tumor, and gamma knife surgery was performed. Conclusions Intracranial chondroma sometimes manifests as intracranial hemorrhage and grows comparatively rapidly in a short period despite the benign histologic features. A long and careful follow-up period is essential.

scholarly journals Computed tomography perfusion as a predictor of delayed cerebral ischemia and functional outcome in spontaneous subarachnoid hemorrhage: A single center experience

2019 ◽  
Vol 32 (3) ◽  
pp. 179-188 ◽  
Author(s):  
Isabel Fragata ◽  
Marta Alves ◽  
Ana Luísa Papoila ◽  
Ana Paiva Nunes ◽  
Patrícia Ferreira ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Clinical Outcome ◽  
Cerebral Perfusion ◽  
Ct Perfusion ◽  
Mean Transit Time ◽  
Multivariable Analysis ◽  
Delayed Cerebral Ischemia ◽  
Spontaneous Subarachnoid Hemorrhage

Background Computed tomography (CT) perfusion has been studied as a tool to predict delayed cerebral ischemia (DCI) and clinical outcome in spontaneous subarachnoid hemorrhage (SAH). The purpose of the study was to determine whether quantitative CT perfusion performed within 72 hours after admission can predict the occurrence of DCI and clinical outcome as measured with a modified Rankin scale (mRS) at 3 months after ictus. Methods Cerebral perfusion was assessed in a prospective cohort of patients with acute SAH. CT perfusion parameters at <72 h post SAH were quantitatively measured in the main vascular territories and represented as whole-brain means. Spearman rank correlation coefficient and generalized additive regression models for binary outcome were used. Results A total of 66 patients underwent CT perfusion at <72 h. Poor clinical grade on admission was correlated with worse cerebral perfusion in all parameters. Multivariable analysis yielded an association of time to peak (TTP; odds ratio (OR) = 0.89; 95% confidence interval (CI): 0.77, 1.02; p = 0.083) with the occurrence of DCI. We also found an association of TTP values with poor outcome, with an 8% increase in the odds of mRS > 3 for each one second increase in TTP at admission (OR = 1.08; 95% CI: 1.00, 1.17; p = 0.061). Conclusions We identified an association of early TTP changes with DCI and poor clinical outcome. However, there were no associations with cerebral blood flow or mean transit time and DCI/clinical outcome. CT perfusion still remains to be validated as a tool in predicting outcome in SAH.

Early ischemic lesion on computed tomography: predictor of poor outcome among survivors of aneurysmal subarachnoid hemorrhage

2007 ◽  
Vol 107 (6) ◽  
pp. 1074-1079 ◽  
Author(s):  
Jari Siironen ◽  
Matti Porras ◽  
Joona Varis ◽  
Kristiina Poussa ◽  
Juha Hernesniemi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Independent Predictor ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Ct Scans ◽  
Ischemic Lesion ◽  
Poor Outcome ◽  
Serial Ct ◽  
Early Lesion

Object Identifying ischemic lesions after subarachnoid hemorrhage (SAH) is important because the appearance of these lesions on follow-up imaging correlates with a poor outcome. The effect of ischemic lesions seen on computed tomography (CT) scans during the first days of treatment remains unknown, however. Methods In 156 patients with SAH, clinical course and outcome, as well as the appearance of ischemic lesions on serial CT scans, were prospectively monitored for 3 months. At 3 months after SAH, magnetic resonance imaging was performed to detect permanent lesions that had not been visible on CT. Results Of the 53 patients with no lesions on any of the follow-up CT scans, four (8%) had a poor outcome. Of the 52 patients with a new hypodense lesion on the first postoperative day CT, 23 (44%) had a poor outcome. Among the remaining 51 patients with a lesion appearing later than the first postoperative morning, 10 (20%) had a poor outcome (p < 0.001). After adjusting for patient age; clinical condition on admission; amounts of subarachnoid, intracerebral, and intraventricular blood; and plasma glucose and D-dimer levels, a hypodense lesion on CT on the first postoperative morning was an independent predictor of poor outcome after SAH (odds ratio 7.27, 95% confidence interval 1.54–34.37, p < 0.05). Conclusions A new hypodense lesion on early postoperative CT seems to be an independent risk factor for poor outcome after SAH, and this early lesion development may be more detrimental to clinical outcome than a later lesion occurrence.

Endovascular Treatment of Intracranial Aneurysms in the Elderly: Single-Center Experience in 63 Consecutive Patients

Neurosurgery ◽  
2005 ◽  
Vol 57 (6) ◽  
pp. 1096-1102 ◽  
Author(s):  
YiLing Cai ◽  
Laurent Spelle ◽  
Huan Wang ◽  
Michel Piotin ◽  
Charbel Mounayer ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Endovascular Procedures ◽  
The Elderly ◽  
High Grade ◽  
Single Center ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms

Abstract OBJECTIVE: With a globally aging population, it is imperative to develop specific treatment strategies for intracranial aneurysms in the elderly. However, the optimal management of intracranial aneurysms in the elderly remains controversial, particularly for the unruptured aneurysms. Although endovascular treatment is increasingly being used for the management of aneurysms, large endovascular series in the elderly population are relatively lacking, especially with regard to the unruptured aneurysms. We present our single-center endovascular experience in treating intracranial aneurysms in 63 consecutive patients 70 years of age and older. METHODS: Between November 1998 and December 2003, among a total of 990 patients with intracranial aneurysms treated endovascularly at our center, 63 patients (6%) were 70 years of age or older. Forty-one patients presented with subarachnoid hemorrhage (SAH), and 22 presented with symptomatic unruptured aneurysms. A total of 84 aneurysms were detected in these 63 patients. Only those responsible for either the subarachnoid hemorrhage or clinical symptoms (68 aneurysms) were treated. The aneurysm characteristics, endovascular procedures and techniques, angiographic and clinical outcomes, and complications were reviewed. RESULTS: Selective embolization failed in three aneurysms (4%). In the remaining 65 aneurysms, complete occlusion was achieved in 33 aneurysms (51%), neck remnant was observed in 17 aneurysms (27%), and residual aneurysmal filling was observed in six aneurysms (9%). Parent vessel occlusion was used in the treatment of nine aneurysms (13%). Thirteen procedure-related complications occurred (19%), six of which resulted in clinical complications (9%). Nine deaths (14%) occurred; three (5%) were directly related to the endovascular procedures, and six (9%) were related to the medical complications of SAH. The remaining 54 patients had a mean clinical follow-up time of 13 months (range, 1–47 mo). Ninety-one percent (20 out of 22) of the patients with unruptured aneurysms and 89% (25/28) of the patients with low-grade (Hunt and Hess Grade I and II) ruptured aneurysms achieved excellent outcomes (modified Rankin Scale score, 0–1), whereas 77% (10 out of 13) of the patients with high-grade (Hunt and Hess Grade ≥ III) ruptured aneurysms either died or had very poor outcomes (modified Rankin Scale score, 4–5). Angiographic follow-up (mean, 11 mo; range, 3–38 mo) was obtained in 34 of the 54 living patients (63%). Two aneurysms demonstrated minor changes that required no further treatment (5%). Five aneurysms showed major recurrences (17%), all of which were successfully retreated endovascularly. CONCLUSION: The elderly patients should merit strong consideration for endovascular treatment of both ruptured and symptomatic unruptured intracranial aneurysms. However, in elderly patients with high-grade subarachnoid hemorrhage, morbidity and mortality rates remain high.

The prognosis in subarachnoid hemorrhage of unknown etiology

1984 ◽  
Vol 61 (6) ◽  
pp. 1029-1031 ◽  
Author(s):  
Vagn Eskesen ◽  
Ebbe B. Sørensen ◽  
Jarl Rosenørn ◽  
Kaare Schmidt
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Mortality Rate ◽  
Functional Capacity ◽  
Unknown Etiology ◽  
Vertebral Angiography ◽  
Content Type ◽  
Moderate Reduction ◽  
Bilateral Carotid ◽  
Fine Print

✓ The mortality rate, risk of rebleeding, relevant subjective and objective symptoms, and daily functional capacity after a verified subarachnoid hemorrhage (SAH) of unknown etiology were evaluated in 44 patients treated during a 5-year period (1978 to 1983). A vascular basis for the SAH had been excluded by bilateral carotid and vertebral angiography and computerized tomography. The patients were interviewed at a follow-up examination from 3 to 64 months (median 36 months) after the bleed. The results revealed a 5% mortality rate and a 7% risk of rebleeding. Persisting headache and fatigue were found in 40% of patients, 29% had mild demential symptoms, and 5% had persisting and severe objective neurological symptoms. None had developed epilepsy. A normal daily functional capacity was enjoyed by 84%, while 14% had a moderate reduction in these functions, but were independent of help from other persons. One patient (2%) was not fully assessed.

scholarly journals Predictive Value of the Serum Albumin Level on Admission in Patients With Spontaneous Subarachnoid Hemorrhage

2021 ◽  
Vol 8 ◽  
Author(s):  
Feng Shang ◽  
Hao Zhao ◽  
Weitao Cheng ◽  
Meng Qi ◽  
Ning Wang ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Serum Albumin ◽  
Serum Albumin Level ◽  
Length Of Hospital Stay ◽  
Albumin Level ◽  
Control Group ◽  
Number Of Patients ◽  
Poor Outcomes ◽  
Spontaneous Subarachnoid Hemorrhage

Objective: To determine the effect of the serum albumin level on admission in patients with spontaneous subarachnoid hemorrhage (SAH).Methods: A total of 229 patients with SAH were divided into control and hypoalbuminemia groups. The serum albumin levels were measured. The data, including age, gender, co-existing medical conditions, risk factors, Hunt-Hess (H-H) grade on admission, Glasgow coma score (GCS) on admission, complications during hospitalizations, length of hospital stay, length of intensive care unit (ICU) stay, in-hospital mortality, survival rate, outcome at discharge, and the 6-month follow-up outcome, were compared between the two groups.Results: Older age, an increased number of patients who consumed an excess of alcohol, and a lower GCS on admission were findings in the hypoalbuminemia group compared to the control group (p &lt; 0.001). The ratio of patients with H-H grade I on admission in the hypoalbuminemia group was decreased compared to the control group (p &lt; 0.05). Patients with hypoalbuminemia were more likely to be intubated, and have pneumonia and cerebral vasospasm than patients with a normal albumin level on admission (p &lt; 0.001). Furthermore, the length of hospital and ICU stays were longer in the hypoalbuminemia group than the control group (p &lt; 0.001). Hypoalbuminemia on admission significantly increased poor outcomes at discharge (p &lt; 0.001). The number of patients with severe disability was increased and the recovery rate was decreased with respect to in-hospital outcomes in the hypoalbuminemia group than the control group (p &lt; 0.001).Conclusion: Hypoalbuminemia was shown to be associated with a poor prognosis in patients with SAH.

Aneurysms at a Temporopolar Artery Origin from the Internal Carotid Artery: Report of Two Cases

Neurosurgery ◽  
2003 ◽  
Vol 52 (5) ◽  
pp. 1221-1253
Author(s):  
Hatem Alkadhi ◽  
Bernhard Schuknecht ◽  
Hans-Georg Imhof ◽  
Yasuhiro Yonekawa
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Clinical Presentation ◽  
Anatomic Variation ◽  
Sudden Onset ◽  
Ruptured Aneurysms ◽  
Supraclinoid Internal Carotid Artery

Abstract OBJECTIVE AND IMPORTANCE Origination of the temporopolar artery (TPA) from the supraclinoid internal carotid artery (ICA) represents a rare anatomic variation, and the presence of aneurysms at this uncommon site has never before been reported. CLINICAL PRESENTATION Two patients presented with a sudden onset of headaches and meningism. Computed tomography demonstrated diffuse subarachnoid hemorrhage in both cases. Cerebral angiography revealed ruptured aneurysms originating at a TPA origin from the ICA. INTERVENTION The patients were surgically treated, and the aneurysms were successfully clipped. For technical reasons, the TPA was sacrificed in both cases. CONCLUSION These are the first reported cases of aneurysms originating at the TPA origin from the ICA. Awareness of the existence of this variation is necessary, particularly for the management of superior wall aneurysms of the ICA.

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