Download PDF
J Neurol Surg A Cent Eur Neurosurg 2016; 77(03): 222-228
DOI: 10.1055/s-0035-1558417
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Clinical Features and Complications in Idiopathic Subarachnoid Hemorrhage: Case Studies

Julio Plata Bello
1   Department of Neurosurgery, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
,
Silvia Acosta-Lopez
1   Department of Neurosurgery, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
,
Victor Garcia-Marin
1   Department of Neurosurgery, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
› Author Affiliations
Further Information

Publication History

25 April 2014

31 March 2015

Publication Date:
27 July 2015 (online)

Also available at
    Permissions and Reprints

Abstract

Background Negative angiography subarachnoid hemorrhage, also known as idiopathic subarachnoid hemorrhage (iSAH), is a challenging pathologic condition whose evolution and final outcome is difficult to predict with certainty. This article describes the clinical features, the type of complications and rates, as well as the final outcome of patients with iSAH.

Methods A prospective evaluation of patients with SAH was performed. Patients with a diagnosis of iSAH were included. Demographic data, clinical features, complication rates, and functional outcomes were all collected. iSAH cases were subsequently compared with patients with aneurysmal SAH (aSAH) taken from the same period.

Results Forty-nine patients fulfilled the criteria for iSAH. Patients with aSAH presented with a worse clinical condition and had a larger amount of blood in the initial computed tomography (CT) scan than iSAH patients. There were no differences in the incidence of acute hydrocephalus, and there was a positive correlation with the Fisher score and the initial clinical status in both groups. Vasospasm was more frequent among patients with aSAH, but the relationship between the incidence of vasospasm and the amount of blood in the initial CT scan was not linear. Good functional outcome was present in > 90% of iSAH patients.

Conclusions Although iSAH generally has a good prognosis, it may be accompanied with serious complications. The incidence of acute hydrocephalus in iSAH is similar to that in aSAH. There is a lower incidence of vasospasm in iSAH than aSAH. A different relationship seems to exist between these complications and the amount of blood in the CT scan.

Keywords

idiopathic subarachnoid hemorrhage - negative angiography - vasospasm - hydrocephalus
 

  • References

  • 1 Sabatino G, Della Pepa GM, Scerrati A , et al. Anatomical variants of the basal vein of Rosenthal: prevalence in idiopathic subarachnoid hemorrhage. Acta Neurochir (Wien) 2014; 156 (1) 45-51
    CrossrefPubMedGoogle Scholar
  • 2 Sabatino G, Della Pepa GM, Albanese A, Marchese E. Angiogram-negative subarachnoid hemorrhage: is it a correct definition?. Acta Neurochir (Wien) 2013; 155 (6) 1127-1129
    CrossrefPubMedGoogle Scholar
  • 3 Farrés MT, Ferraz-Leite H, Schindler E, Mühlbauer M. Spontaneous subarachnoid hemorrhage with negative angiography: CT findings. J Comput Assist Tomogr 1992; 16 (4) 534-537
    CrossrefPubMedGoogle Scholar
  • 4 Ferbert A, Hubo I, Biniek R. Non-traumatic subarachnoid hemorrhage with normal angiogram. Long-term follow-up and CT predictors of complications. J Neurol Sci 1992; 107 (1) 14-18
    CrossrefPubMedGoogle Scholar
  • 5 Pinto AN, Ferro JM, Canhão P, Campos J. How often is a perimesencephalic subarachnoid haemorrhage CT pattern caused by ruptured aneurysms?. Acta Neurochir (Wien) 1993; 124 (2-4) 79-81
    CrossrefPubMedGoogle Scholar
  • 6 van Gijn J, Rinkel GJ. Subarachnoid haemorrhage: diagnosis, causes and management. Brain 2001; 124 (Pt 2): 249-278
    CrossrefPubMedGoogle Scholar
  • 7 Giombini S, Bruzzone MG, Pluchino F. Subarachnoid hemorrhage of unexplained cause. Neurosurgery 1988; 22 (2) 313-316
    CrossrefPubMedGoogle Scholar
  • 8 Nishioka H, Torner JC, Graf CJ, Kassell NF, Sahs AL, Goettler LC. Cooperative study of intracranial aneurysms and subarachnoid hemorrhage: a long-term prognostic study. III. Subarachnoid hemorrhage of undetermined etiology. Arch Neurol 1984; 41 (11) 1147-1151
    CrossrefPubMedGoogle Scholar
  • 9 Rinkel GJ, Wijdicks EF, Vermeulen M , et al. Nonaneurysmal perimesencephalic subarachnoid hemorrhage: CT and MR patterns that differ from aneurysmal rupture. AJNR Am J Neuroradiol 1991; 12 (5) 829-834
    PubMedGoogle Scholar
  • 10 Tatter SB, Crowell RM, Ogilvy CS. Aneurysmal and microaneurysmal “angiogram-negative” subarachnoid hemorrhage. Neurosurgery 1995; 37 (1) 48-55
    CrossrefPubMedGoogle Scholar
  • 11 Van Calenbergh F, Plets C, Goffin J, Velghe L. Nonaneurysmal subarachnoid hemorrhage: prevalence of perimesencephalic hemorrhage in a consecutive series. Surg Neurol 1993; 39 (4) 320-323
    CrossrefPubMedGoogle Scholar
  • 12 Canhão P, Ferro JM, Pinto AN, Melo TP, Campos JG. Perimesencephalic and nonperimesencephalic subarachnoid haemorrhages with negative angiograms. Acta Neurochir (Wien) 1995; 132 (1–3) 14-19
    CrossrefPubMedGoogle Scholar
  • 13 Iwanaga H, Wakai S, Ochiai C, Narita J, Inoh S, Nagai M. Ruptured cerebral aneurysms missed by initial angiographic study. Neurosurgery 1990; 27 (1) 45-51
    CrossrefPubMedGoogle Scholar
  • 14 Kaim A, Proske M, Kirsch E, von Weymarn A, Radü EW, Steinbrich W. Value of repeat-angiography in cases of unexplained subarachnoid hemorrhage (SAH). Acta Neurol Scand 1996; 93 (5) 366-373
    PubMedGoogle Scholar
  • 15 Spallone A, Ferrante L, Palatinsky E, Santoro A, Acqui M. Subarachnoid haemorrhage of unknown origin. Acta Neurochir (Wien) 1986; 80 (1–2) 12-17
    CrossrefPubMedGoogle Scholar
  • 16 Topcuoglu MA, Ogilvy CS, Carter BS, Buonanno FS, Koroshetz WJ, Singhal AB. Subarachnoid hemorrhage without evident cause on initial angiography studies: diagnostic yield of subsequent angiography and other neuroimaging tests. J Neurosurg 2003; 98 (6) 1235-1240
    CrossrefPubMedGoogle Scholar
  • 17 Little AS, Garrett M, Germain R , et al. Evaluation of patients with spontaneous subarachnoid hemorrhage and negative angiography. Neurosurgery 2007; 61 (6) 1139-1150 ; discussion 1150–1151
    CrossrefPubMedGoogle Scholar
  • 18 Whiting J, Reavey-Cantwell J, Velat G , et al. Clinical course of nontraumatic, nonaneurysmal subarachnoid hemorrhage: a single-institution experience. Neurosurg Focus 2009; 26 (5) E21
    CrossrefPubMedGoogle Scholar
  • 19 Khan AA, Smith JDS, Kirkman MA , et al. Angiogram negative subarachnoid haemorrhage: outcomes and the role of repeat angiography. Clin Neurol Neurosurg 2013; 115 (8) 1470-1475
    CrossrefPubMedGoogle Scholar
  • 20 Duong H, Melançon D, Tampieri D, Ethier R. The negative angiogram in subarachnoid haemorrhage. Neuroradiology 1996; 38 (1) 15-19
    CrossrefPubMedGoogle Scholar
  • 21 Hütter BO, Gilsbach JM, Kreitschmann I. Is there a difference in cognitive deficits after aneurysmal subarachnoid haemorrhage and subarachnoid haemorrhage of unknown origin?. Acta Neurochir (Wien) 1994; 127 (3–4) 129-135
    CrossrefPubMedGoogle Scholar
  • 22 Jung JY, Kim YB, Lee JW, Huh SK, Lee KC. Spontaneous subarachnoid haemorrhage with negative initial angiography: a review of 143 cases. J Clin Neurosci 2006; 13 (10) 1011-1017
    CrossrefPubMedGoogle Scholar
  • 23 van Gijn J, van Dongen KJ, Vermeulen M, Hijdra A. Perimesencephalic hemorrhage: a nonaneurysmal and benign form of subarachnoid hemorrhage. Neurology 1985; 35 (4) 493-497
    CrossrefPubMedGoogle Scholar
  • 24 Dalyai R, Chalouhi N, Theofanis T , et al. Subarachnoid hemorrhage with negative initial catheter angiography: a review of 254 cases evaluating patient clinical outcome and efficacy of short- and long-term repeat angiography. Neurosurgery 2013; 72 (4) 646-652 ; discussion 651–652
    PubMedGoogle Scholar
  • 25 Andrioli GC, Salar G, Rigobello L, Mingrino S. Subarachnoid haemorrhage of unknown aetiology. Acta Neurochir (Wien) 1979; 48 (3–4) 217-221
    CrossrefPubMedGoogle Scholar
  • 26 Béguelin C, Seiler R. Subarachnoid hemorrhage with normal cerebral panangiography. Neurosurgery 1983; 13 (4) 409-411
    CrossrefPubMedGoogle Scholar
  • 27 Hayward RD. Subarachnoid haemorrhage of unknown aetiology. A clinical and radiological study of 51 cases. J Neurol Neurosurg Psychiatry 1977; 40 (9) 926-931
    CrossrefPubMedGoogle Scholar
  • 28 Koçak A, Saraç K, Ateş O, Caylỳ SR. Severe cerebral vasospasm caused by non-aneurysmal subarachnoid hemorrhage treatment with transluminal balloon angioplasty. Minim Invasive Neurosurg 2007; 50 (1) 23-26
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Rinkel GJ, Wijdicks EF, Hasan D , et al. Outcome in patients with subarachnoid haemorrhage and negative angiography according to pattern of haemorrhage on computed tomography. Lancet 1991; 338 (8773) 964-968
    CrossrefPubMedGoogle Scholar
  • 30 Sheehan JM, Cloft H, Kassell NF. Symptomatic delayed arterial spasm following non-aneurysmal perimesencephalic subarachnoid hemorrhage: a case report and review of the literature. Acta Neurochir (Wien) 2000; 142 (6) 709-712
    CrossrefPubMedGoogle Scholar
  • 31 Gross BA, Lin N, Frerichs KU, Du R. Vasospasm after spontaneous angiographically negative subarachnoid hemorrhage. Acta Neurochir (Wien) 2012; 154 (7) 1127-1133
    CrossrefPubMedGoogle Scholar
  • 32 Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet 1975; 1 (7905) 480-484
    Google Scholar
  • 33 Velthuis BK, Rinkel GJ, Ramos LM , et al. Subarachnoid hemorrhage: aneurysm detection and preoperative evaluation with CT angiography. Radiology 1998; 208 (2) 423-430
    CrossrefPubMedGoogle Scholar
  • 34 Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 1980; 6 (1) 1-9
    CrossrefPubMedGoogle Scholar
  • 35 Kistler JP, Crowell RM, Davis KR , et al. The relation of cerebral vasospasm to the extent and location of subarachnoid blood visualized by CT scan: a prospective study. Neurology 1983; 33 (4) 424-436
    CrossrefPubMedGoogle Scholar
  • 36 Lasner TM, Raps EC. Clinical evaluation and management of aneurysmal subarachnoid hemorrhage. Neuroimaging Clin N Am 1997; 7 (4) 669-678
    PubMedGoogle Scholar
  • 37 Rabb CH, Tang G, Chin LS, Giannotta SL. A statistical analysis of factors related to symptomatic cerebral vasospasm. Acta Neurochir (Wien) 1994; 127 (1–2) 27-31
    CrossrefPubMedGoogle Scholar
  • 38 Mayberg MR, Batjer HH, Dacey R , et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 1994; 25 (11) 2315-2328
    CrossrefPubMedGoogle Scholar
  • 39 Kassell NF, Sasaki T, Colohan AR, Nazar G. Cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Stroke 1985; 16 (4) 562-572
    CrossrefPubMedGoogle Scholar
  • 40 Artiola i Fortuny L, Prieto-Valiente L. Long-term prognosis in surgically treated intracranial aneurysms. Part 1: Mortality. J Neurosurg 1981; 54 (1) 26-34
    CrossrefPubMedGoogle Scholar
  • 41 Dorsch NW, King MT. A review of cerebral vasospasm in aneurysmal subarachnoid haemorrhage. Part I: Incidence and effects. J Clin Neurosci 1994; 1 (1) 19-26
    CrossrefPubMedGoogle Scholar
  • 42 Fisher CM, Roberson GH, Ojemann RG. Cerebral vasospasm with ruptured saccular aneurysm—the clinical manifestations. Neurosurgery 1977; 1 (3) 245-248
    CrossrefPubMedGoogle Scholar
  • 43 Hsu W, Pradilla G, Garonzik IM, Conway JE. Pretruncal nonaneurysmal subarachnoid hemorrhage causing basilar artery vasospasm. Neurocrit Care 2010; 13 (2) 256-260
    CrossrefPubMedGoogle Scholar
  • 44 Qureshi AI, Suarez JI, Bhardwaj A, Yahia AM, Tamargo RJ, Ulatowski JA. Early predictors of outcome in patients receiving hypervolemic and hypertensive therapy for symptomatic vasospasm after subarachnoid hemorrhage. Crit Care Med 2000; 28 (3) 824-829
    CrossrefPubMedGoogle Scholar
  • 45 Ropper AH, Zervas NT. Outcome 1 year after SAH from cerebral aneurysm. Management morbidity, mortality, and functional status in 112 consecutive good-risk patients. J Neurosurg 1984; 60 (5) 909-915
    CrossrefPubMedGoogle Scholar
  • 46 Schaller C, Rohde V, Meyer B, Hassler W. Amount of subarachnoid blood and vasospasm: current aspects. A transcranial Doppler study. Acta Neurochir (Wien) 1995; 136 (1-2) 67-71
    CrossrefPubMedGoogle Scholar
  • 47 Rowland MJ, Hadjipavlou G, Kelly M, Westbrook J, Pattinson KT. Delayed cerebral ischaemia after subarachnoid haemorrhage: looking beyond vasospasm. Br J Anaesth 2012; 109 (3) 315-329
    CrossrefPubMedGoogle Scholar
  • 48 Carr KR, Zuckerman SL, Mocco J. Inflammation, cerebral vasospasm, and evolving theories of delayed cerebral ischemia. Neurol Res Int 2013; 2013: 506584
    PubMedGoogle Scholar
  • 49 Rothoerl RD, Axmann C, Pina A-L, Woertgen C, Brawanski A. Possible role of the C-reactive protein and white blood cell count in the pathogenesis of cerebral vasospasm following aneurysmal subarachnoid hemorrhage. J Neurosurg Anesthesiol 2006; 18 (1) 68-72
    CrossrefPubMedGoogle Scholar
  • 50 Parkinson D, Stephensen S. Leukocytosis and subarachnoid hemorrhage. Surg Neurol 1984; 21 (2) 132-134
    CrossrefPubMedGoogle Scholar