OBJECTIVES: The aim of this study was to work out the special features of subarachnoid hemorrhage (SAH) of unknown origin in respect of diagnostic evaluation, clinical course, and outcome in a large cohort of patients. METHODS: We reviewed the data of 179 patients with SAH of unknown origin during 1991 and 2008. The differentiation between perimesencephalic (PM-SAH) and non-perimesencephalic SAH (NON-PM-SAH) was done under consideration of the bleeding pattern on CT scanning. RESULTS: Among 1226 treated patients with spontaneous SAH over a time period of 17 years, a bleeding source remained undetected on first digital subtraction angiogram (DSA) in 179 patients (16.7%)--47 PM-SAH (26.3%) and 132 NON-PM-SAH (73.7%). The clinical signs of patients with PM-SAH were less marked compared to those with NON-PM-SAH, equally to the Hunt and Hess grade. magnetic resonance imaging (MRI) and MR angiography had 100% negative findings for non-aneurismal bleeding sources in all patients. Second DSA revealed a bleeding source in the NON-PM group in 10.8%. The clinical course of the patients with NON-PM-SAH showed a significantly higher rate of complications and a mortality of about 10%. The outcome was excellent in the PM group, in contrast to a fatal course in 13 cases in the NON-PM group. DISCUSSION: PM-SAH imposed with a mild clinical course and an excellent outcome, without severe complications. In contrast to this, NON-PM-SAH has a significant higher rate of dreaded complications and mortality. It is crucial to make an exact diagnosis of PM-SAH, considering CT scanning during the first 24 hours after occurrence of symptoms and the radiological features.
OBJECTIVES: The aim of this study was to work out the special features of subarachnoid hemorrhage (SAH) of unknown origin in respect of diagnostic evaluation, clinical course, and outcome in a large cohort of patients. METHODS: We reviewed the data of 179 patients with SAH of unknown origin during 1991 and 2008. The differentiation between perimesencephalic (PM-SAH) and non-perimesencephalic SAH (NON-PM-SAH) was done under consideration of the bleeding pattern on CT scanning. RESULTS: Among 1226 treated patients with spontaneous SAH over a time period of 17 years, a bleeding source remained undetected on first digital subtraction angiogram (DSA) in 179 patients (16.7%)--47 PM-SAH (26.3%) and 132 NON-PM-SAH (73.7%). The clinical signs of patients with PM-SAH were less marked compared to those with NON-PM-SAH, equally to the Hunt and Hess grade. magnetic resonance imaging (MRI) and MR angiography had 100% negative findings for non-aneurismal bleeding sources in all patients. Second DSA revealed a bleeding source in the NON-PM group in 10.8%. The clinical course of the patients with NON-PM-SAH showed a significantly higher rate of complications and a mortality of about 10%. The outcome was excellent in the PM group, in contrast to a fatal course in 13 cases in the NON-PM group. DISCUSSION: PM-SAH imposed with a mild clinical course and an excellent outcome, without severe complications. In contrast to this, NON-PM-SAH has a significant higher rate of dreaded complications and mortality. It is crucial to make an exact diagnosis of PM-SAH, considering CT scanning during the first 24 hours after occurrence of symptoms and the radiological features.
Authors: J E Delgado Almandoz; B M Crandall; J L Fease; J M Scholz; R E Anderson; Y Kadkhodayan; D E Tubman Journal: AJNR Am J Neuroradiol Date: 2012-09-27 Impact factor: 3.825
Authors: A Ringelstein; O Mueller; S L Goericke; C Moenninghoff; U Sure; I Wanke; M Forsting; M Schlamann Journal: Clin Neuroradiol Date: 2013-11-28 Impact factor: 3.649
Authors: J J Heit; G T Pastena; R G Nogueira; A J Yoo; T M Leslie-Mazwi; J A Hirsch; J D Rabinov Journal: AJNR Am J Neuroradiol Date: 2015-09-03 Impact factor: 3.825
Authors: J M Coutinho; R H Sacho; J D Schaafsma; R Agid; T Krings; I Radovanovic; C C Matouk; D J Mikulis; D M Mandell Journal: Clin Neuroradiol Date: 2015-11-25 Impact factor: 3.649
Authors: Midhun Mohan; Abdurrahman I Islim; Fahid T Rasul; Ola Rominiyi; Ruth-Mary deSouza; Michael T C Poon; Aimun A B Jamjoom; Angelos G Kolias; Julie Woodfield; Krunal Patel; Aswin Chari; Ramez Kirollos Journal: Acta Neurochir (Wien) Date: 2019-08-13 Impact factor: 2.216