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Journal of Korean Neurosurgical Society > Volume 34(5); 2003 > Article
Journal of Korean Neurosurgical Society 2003;34(5): 433-439.
The Management Strategy of Spontaneous Subarachnoid Hemorrhage in Patients with Initial Negative Angiogram.
Young Seok Park, Yong Bae Kim, Seung Kon Huh, Kyu Chang Lee
Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea. sk522@yumc.yonsei.ac.kr
ABSTRACT
OBJECTIVE:
The aim of this retrospective clinical study is to provide a proper management strategy for patients who present spontaneous subarachnoid emorrhage(SAH) with negative initial angiogram by investigating the clinical features, long-term outcomes and radiologic characteristics.
METHODS:
One hundred and twenty-eight out of 2887 SAH patients who were admitted to neurosurgery department from 1986 to 2002 had negative initial angiogram. We classified the 128 patients into 3 groups(Group I: no evidence of SAH on CT but confirmed by lumbar puncture, Group II: perimesencephalic(PM) SAH pattern, Group III: non-perimesencephalic(NPM) SAH pattern), and reviewed the radiologic findings, the clinical features, the rebleeding rate, the long-term outcome, and the results of repeated angiogram. Factors related to the false negative initial angiogram were also reviewed.
RESULTS:
The patients were 9(7.0%) in Group l, 85(66.4%) in Group ll, and 34(26.6%) in Group lll. There was no difference in long-term clinical outcome. Ninety-two out of 128 patients underwent a repeated angiogram in which 18 patients were found to have ruptured aneurysms that were not detected on the initial angiogram(false negative rate: overall 19.6%, 1.8% in Group II, 50.0% in Group lll). Small size( < 6mm) aneurysms, spasms, hematomas, and anterior communicating aneurysms were the factors affecting false negative initial angiogram.
CONCLUSION:
In SAH patients with negative initial angiogram, espeacially those who had a non-perimesencephalic SAH pattern on initial CT findings, a repeated angiogram should be considered for identifying the hidden ruptured aneurysm.
Key Words: Subarachnoid hemorrhage; CT findings; Cerebral angiogram; False negative
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