Subarachnoid hemorrhage with normal cerebral panangiography.

Forty-two nonhypertensive patients with a proven subarachnoid hemorrhage but normal cerebral panangiography were in vestigated. The follow-up period was 1 to 5 years, with a mean of 39.1 months. Treatment consisted of 2 weeks of bedrest and sedation, followed by progressive mobilization on the 3rd week. Thirteen patients (Group A) were treated with tranexamic acid, whereas 29 patients (Group B) received no antifibrinolytic therapy. Five patients Of Group A died of ischemia caused by cerebral vasospasm. No patient of Group B died, and there was no early rebleeding in either group. Therefore, antifibrinolytic therapy is not indicated in these patients. Only 1 of 42 patients (2.4%) experienced late rebleeding, and he again had normal cerebral panangiography. Reangiography several weeks or months after the first hemorrhage seems not to be indicated. The overall prognosis of the surviving patients was good; almost all were able to return to their previous occupations within 6 months after the hemorrhage.