Subarachnoid Hemorrhage and negative angiography - What is next ?

[Encephalos Administrator]

Neurosurgery journal in its December 2007 issue, hosts an article
about spontaneous SAH and negative angiography by Dr Little et al, at
Barrow Neurosurgical Institute, Phoenix, Arizona. The authors
retrospectively studied 100 patients with spontaneous SAH and negative
angiographies. A cause was determined in 13 patients (13%), with
aneurysm finding in 7 patients. They state that repeat angio was the
most useful in detecting the lesions. The second angio scored best
when a classic hemorrhagic pattern was met. Five patients with
thrombosed aneurysms were not detected with first angio. One cervical
ependymoma was found using spinal MRI and other factors, like
antiplatelet therapy and drug use were found in 13 patients.

The authors finally propose three new diagnostic algorithms concerning
the SAH with negative angiography, based on their findings.

THE DEBATE IS RAISED....

SAH and negative angiography is a differential diagnostic problem that
its solution is imperative since the possibility of hemorrhage
recurrence could be disastrous. The authors provide us with useful
algorithms that interpret findings in the literature and try to solve
diagnostic problems and precede unfortunate outcomes.

Your comments would contribute to the discussion thread.

What algorithm do you follow when you encounter a Subarachnoid
Hemorrhage case with negative angiography ?

What is the best for you and what literature indicates ?


This article is under the copyright © of Dr Little et al and Congress
of Neurological Surgeons. All rights reserved.
Neurosurgery is published by Lippincott Williams & Wilkins.