Frequency of Aneurysmal Subarachnoid Hemorrhage in Perimesencephalic Subarachnoid Hemorrhage and Need of 4-vessel Angiography

OBJECTIVE: In this study, each of the frequency of nonaneurysmal perimesencephalic subarachnoid hemorrhage(N-PMSH), and the clinical and radiologic features, incidence and location of aneurysmal perimesencephalic subarachnoid hemorrhage(A-PMSH), based on aneurysmal rupture and nonaneurysmal subarachnoid hemorrhage in patients with spontaneous subarachnoid hemorrhage, are investigated for clinical application. METHODS: Patients who showed perimesencephalic subarachnoid hemorrhage, among the 388 patients with subarachnoid hemorrhage admitted into the our hospital from March 1994 to November 2002, were extracted ; and their charts and angiographies were examined retrospectively. They were divided into two groups - aneurysmal perimesencephalic subarachnoid hemorrhage group and nonaneurysmal perimesencephalic subarachnoid hemorrhage group - and comparative analysis was conducted on the clinical patterns and radiologic characteristics of each group. RESULTS: There were 22 patients(5.68%) with perimesencephalic subarachnoid hemorrhage(PMSH) among 388 patients with spontaneous subarachnoid hemorrhage. Of the 22 PMSH, 8 patients(36%) were aneurysmal PMSH(A-PMSH), 14 patients(64%) were nonaneurysmal PMSH(N-PMSH). N-PMSH occurred not only in the posterior circulation(5 cases), but also in the anterior circulation(3 cases). There was no difference in the CT features of PMSH between aneurysmal and nonaneurysmal cause. CONCLUSION: According to the above results, 4-vessel angiography is essential for patients with perimesencephalic subarachnoid hemorrhage, and CTA and MRA can be used as assisting diagnosis methods.

Comparative Analysis of Magnetic Resonance Angiography and 4-Vessel Angiography in the Diagnosis of Pediatric Moyamoya Disease / 대한소아신경학회지

PURPOSE: Conventional 4-vessel cerebral angiography has been considered as a gold standard for the diagnosis of Moyamoya disease. However, it is an invasive procedure requiring general anesthesia and various neurologic complications such as TIA and cerebral infarction are ocassionally reported during the procedure in children with unstable Moyamoya disease. This study was performed to evaluate the diagnostic efficacy of safe and non-invasive magnetic resonance angiography(MRA) with compared to the cerebral angiography in children with Moyamoya disease. METHODS: MRA and 4-vessel angiography of 9 patients admitted at Ajou University Hospital from June 1994 to December 2000 with Moyamoya disease were comparatively reviewed retrospectively. Diagnostic accuracy, predictive value of evaluating the disease progress, and differential estimation of the stenosis of cerebral vessels from occlusion were comparatively analyzed. RESULTS: The sensitivity and specificity of the brain MRA in the diagnosis of Moyamoya disease was 100%. There is no statistically significant difference in the estimation of Suzuki stage between MRA and cerebral angiography(P=0.180). The sensitivity and specificity of the brain MRA to differentiate occlusion from the stenosis of cerebral vessel were 33% and 100%. In patients with stage III and IV Moyamoya disease, MRA showed sensitivity of 100% and specificity of 100% to predict vascular occlusion, and sensitivity of 100% and specificity of 66.7% to differentiate the degree of stenosis. CONCLUSION: In our study, MRA was proved to be a very accurate diagnostic tool in children with Moyamoya disease. Therefore, MRA will be an alternative, safe, and non-invasive diagnostic tool to substitude the cerebral angiography in the near future.