Subarachnoid Hemorrhage with Negative Initial Angiography

ABSTRACT

In 614 of 793 cases with subarachnoid hemorrhage(SAH), four vessel cerebral angiography was performed to investigate the source of the hemorrhage. The first four vessel study revealed 501 cases of ruptured cerebral aneurysms; during initial pan-angiography studies, 113 SAH patients did not show vascular lesions. Thirty two of 71 patients(45.1%) showed aneurysms on repeat angiography fifteen of them had aneurysms in the anterior communicating artery. Among patients whose Hunt Hess grade on admission was poor(III-IV), the possibility of revealing aneurysm during repeated angiography was higher than in those whose grade was good(I-II)(p<0.05, Fisher exact test). On repeat angiography, the age, sex and CT grade of patients with aneurysm were indistinguishable from those of patients without even in those who on initial angiography showed angiographic vasospasm, the chance of revealing an aneurysm was the same as in those without spasm. We concluded that repeated angiography, especially after 3 weeks of ictus, was valuable for the detection of an initially undefined aneurysm.