Introduction: It is well known that rupture of an intracranial aneurysm constitutes the most common cause of spontaneous subarachnoid hemorrhage (sSAH). However, in approximately 20% of sSAH cases, no aneurysm or other vascular pathology can be detected, despite their proper imaging workup. In our current communication, we present our results regarding the mid-term outcome of patients with angiographically negative sSAH.
Methods: Forty one patients (17M and 24F), with a mean age 51.8 years (range 28-72) with CT-established diagnosis of SAH were included in our prospective study. Digital subtraction angiography (DSA) was routinely obtained upon admission, and then again between the 10th -14th post-ictal days (if there is a non peri-mesencephalic hemorrhage pattern, otherwise we repeat a brain MRA on the 30th post-ictal day). Admitting Glasgow Coma Scale (GCS) score, Fisher, and Hunt and Hess (H-H) grades were documented. All participants were classified according to the distribution of blood on the obtained CT, to peri-mesencephalic and non peri-mesencephalic hemorrhage patterns. In addition, brain CTA and MRA, along with brain and cervical spine MRIs were employed in all participants. Their clinical outcome was evaluated by applying the Glasgow Outcome (GOS) and the modified Rankin Scales (mRS). The mean follow-up time in our study was 29.66 months (range 1-36).
Results: All of our patients were admitted with H-H grades I/II and GCS scores 14 and 15. Twenty four patients (58.56%) had peri-mesencephalic hemorrhage, 16 (39.02%) non peri-mesencephalic, and 1 (2.44%) had solely intraventricular hemorrhage. All participants were discharged with GOS 4/5 and mRS 0/1. We observed a case of sudden death, three weeks after the patient’s discharge.
Conclusions: Despite the belief that sSAH with negative angiogram is considered a benign clinical entity, mid-term complications such as rebleeding, and/or ischemia may occur in these patients. Further study is necessary for outlining the prognosis of this entity.
Patient Care: We propose that significant morbidity and even mortality can be seen in the context of this benign clinical entity.
Learning Objectives: 1.Participants will learn the incidence of angiographically-negative spontaneous SAH.
2.Discuss the diagnostic approach of these patients.
3.Evaluate the mid-term prognosis and the potential adverse events of the disease.