Türk Nöroşirürji Dergisi 2014 , Vol 24 , Num 3
Subarachnoid Hemorrhage with Negative Angiography: Clinical Course, Diagnostic Yield of Repeat Angiographies and Long-Term Results
Ethem GÖKSU1, Barış Özgür ÇAPAR1, Özhan ÖZGÜR2, Mahmut AKYÜZ1, Saim KAZAN1, Timur SİNDEL2, Recai TUNCER1
1Akdeniz Üniversitesi, Tıp Fakültesi, Nöroşirürji Anabilim Dalı, Antalya, Türkiye
2Akdeniz Üniversitesi, Tıp Fakültesi, Radyoloji Anabilim Dalı, Antalya, Türkiye
AIM: To investigate the clinical course, the diagnostic yield of repeat angiographies, and long-term results in patients with spontaneous subarachnoid hemorrhage (SAH) and negative angiography.

MATERIAL and METHODS: Consecutive patients diagnosed with spontaneous SAH and who had negative initial catheter angiography results between 1998 and 2013 were studied retrospectively. SAH was diagnosed with computed tomography (CT) or lumbar puncture (LP). Digital subtraction angiography (DSA) or three-dimensional computed tomographic angiography (3DCTA) was repeated on the second week from the initial hemorrhage. The patients were classified as perimesencephalic, diff use or CT-negative according to CT findings. Short-term and long-term results were assessed with the Glasgow Outcome Scale (GOS).

RESULTS: The SAH was perimesencephalic in 45.2%, diff use in 35.7%, and CT negative in 19%. There was no patient with a Hunt–Hess score of 4 or 5. No diagnostic yield was observed with repeat angiographies. There was no rebleeding episode during the short-term or long-term follow-up in any patient.

CONCLUSION: Angiography negative SAH’s have a more benign clinical course than that of aneurysmatic SAH’s. The pattern of hemorrhage is the most important diagnostic parameter and a diff use SAH pattern has higher complication rates. Aggressive protocols may not be necessary in patients with perimesensephalic and CT-negative SAH. Anahtar Kelimeler : Subarachnoid hemorrhage, Negative angiography, Diagnostic yield, Long-term follow-up