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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

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Subarachnoid hemorrhage with negative initial catheter angiography in a series of 71 patients

Subarachnoidale Blutung mit einer initial negativenKatheterangiographie in 71 Patienten

Meeting Abstract

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  • presenting/speaker Josef Michael Lang - Medizinische Hochschule Hannover, Klinik für Neurochirurgie, Hannover, Deutschland
  • Friedrich Götz - Medizinische Hochschule Hannover, Institut für Diagnostische und Interventionelle Neuroradiologie, Hannover, Deutschland
  • Joachim K. Krauss - Medizinische Hochschule Hannover, Klinik für Neurochirurgie, Hannover, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocV094

doi: 10.3205/19dgnc109, urn:nbn:de:0183-19dgnc1096

Veröffentlicht: 8. Mai 2019

© 2019 Lang et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

Objective: To assess the causes and spectrum of initially negative catheter angiography in patients with non-traumatic subarachnoid hemorrhage (nSAH).

Methods: Analysis of a consecutive series of 449 patients with nSAH over a period of 9 years (2009–2017) with negative initial catheter angiography.

Results: There were 71 from 449 patients (15,8 %) patients (38 men, 33 women with a mean age of 54 years, range 17-87 years) with a negative initial catheter angiography. 45 patients (63,4%) presented with a perimesencephalic SAH (PMSAH) pattern, 26 patients (36,6%) with non-perimesencephalic SAH (NPMSAH). Follow-up catheter angiography with 3-dimensional presentation detected an aneurysm as bleeding source in 3 from 26 patients with NPMSAH, in one patient MRI showed a thrombosed cerebral aneurysm causative for hemorrhage (NPMSAH). In two patients with NPMSAH pattern (cortical SAH) MRI revealed amyloidangiopathy. In 20 from 26 patients (77.0%) with NPMSAH and negative initial catheter angiography the bleeding source remained unclear.

Conclusion: Totally, in 71 from 449 patients with nSAH (15,8%) initial catheter angiography was negative. Follow-up catheter angiography plus additional head MRI failed to detect a bleeding source in 20 patients with NPMSAH pattern and initial negative catheter angiogram. In patients with typical PMSAH pattern follow-up catheter angiography is not recommended any longer. For patients with NPMSAH pattern and negative initial catheter angiogram follow-up catheter angiography with 3-dimensional presentation and MRI imaging are advised to rule out a bleeding source 2-4 weeks after the first angiography.