Artikel
Spinal ependymoma as bleeding-source in non-aneurysmal subarachnoid hemorrhage: a retrospective study
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Autoren
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Sepide Kashefiolasl
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Frankfurt
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Nina Brawanski
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Frankfurt
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Johannes Platz
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Frankfurt
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Christian Senft
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Frankfurt
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Volker Seifert
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Frankfurt
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Jürgen Konczalla
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Frankfurt
| Veröffentlicht: | 2. Juni 2015 |
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Gliederung
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Objective: In up to 15% of all spontaneous subarachnoid hemorrhages (SAH), there is no intracranial vascular pathology found. The evaluation of patients with subarachnoid hemorrhage with negative digital subtraction angiography (DSA) is a diagnostic challenge. These cases of non-aneurysmal hemorrhages are categorized into perimesencephalic SAH (PM-SAH) and non-perimesencephalic SAH (NPM-SAH). Spontaneous subarachnoid hemorrhage due to spinal pathology is very rare but searching for a spinal origin in non-aneurysmal SAH might be reasonable sometimes.
Method: We retrospectively investigated the yield of clinical and radiological characteristics in 190 patients with spontaneous non-aneurysmal SAH, diagnosed by computed tomography (CT), lumbar puncture, and negative digital subtraction angiography (DSA).
Qualified patients were registered for assessment of the complete spinal axis by standard MR-imaging.
Results: 190 non-aneurysmal SAH patients aged 58,5 ± 3,5 years were included in the study, divided into perimesencephalic SAH (PMSAH) (n=89; 47%) and non-perimesencephalic SAH (NPSAH) (n=101; 53%). Baseline characteristics were compared between these two categories. Magnetic resonance imaging of the spinal axis detected two patients with lumbar ependymoma (n=2; 1,05%). Both patients complained of lumboischialgia and had a NPM-SAH. Overall, 23 patients with a non-perimesencephalic SAH and negative computed tomographic scan were diagnosed by positive lumbar puncture.
One of the two patients was a 24-year-old male, who was diagnosed by lumbar puncture. The other one was a 37-year-old male and diagnosed with a positive CT scan of NPM-SAH. No spinal origin for the SAH was found in 89 PMSAH patients.
Conclusions: Spontaneous subarachnoid hemorrhage caused by spinal pathology is very rare. Routine radiological investigation of the spinal axis in every non-aneurysmal SAH patients is therefore not recommended. However, MR-imaging of the complete spinal axis in patients with lumboischialgia and a NPM-SAH can be useful and reasonable to detect this rare entity of SAH.
