gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

Subarachnoid hemorrhage without aneurysm on the angiogram: the value of repeat angiography

Subarachnoidalblutung ohne angiographischen Aneurysmanachweis: die Bedeutung der Kontrollangiographie

Meeting Abstract

  • corresponding author A. Weyerbrock - Abteilung Allgemeine Neurochirurgie, Universitätsklinik Freiburg
  • B. Baumer - Abteilung Allgemeine Neurochirurgie, Universitätsklinik Freiburg
  • A. Berlis - Sektion Neuroradiologie, Neurochirurgische Universitätsklinik, Freiburg
  • S. Rosahl - Abteilung Allgemeine Neurochirurgie, Universitätsklinik Freiburg

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc10.05.-15.03

The electronic version of this article is the complete one and can be found online at:

Published: May 4, 2005

© 2005 Weyerbrock et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.




The purpose of this study was to review the incidence of negative cerebral panangiography using modern DSA technique in acute nontraumatic subarachnoid hemorrhage (SAH), to determine the yield of repeat angiography and optional additional MR imaging and to investigate the clinical presentation and the short and long-term outcome of these patients.


All diagnostic data of patients with spontaneous SAH admitted to the Department of Neurosurgery in Freiburg between 1992 and 2003 were analysed retrospectively. The imaging data (CT, angiography, MRI) during acute state, the repeat angiography, the clinical grade at admission and the outcome as determined by the MRS (modified Rankin Scale) were evaluated statistically.


Among 739 SAH patients, no aneurysm could be detected in 144 patients (19.5%), 130 (17.6%) had negative angiograms, 14 had no angiogram because of poor clinical grade or death. Mean age was 53.6±11 years. 58.5% were H&H I, 17.7% were grade II or grade III, respectively, the remaining 6 % were grade IV or V. Repeat angiogram was performed in 55% of the patients, additional MRI in 18%. No “occult” aneurysms or other vascular malformations were detected on repeat angiograms. 5 patients had infundibula which had already been seen on the first angiogram, 3 of these patients had explorative surgery confirming the angiographic finding. In one patient, the cause of SAH was a dural AV-fistula which was treated by coiling. There was one false-positive angiogram where an infratentorial AVM was suspected which was not confirmed on repeat angiography. MR imaging did not lead to the detection of further bleeding sources. Short-term MRS scores were obtained in 100%, long-term MRS in 66% after a mean follow-up time of 58 months. At discharge from the hospital, 83.1% had good MRS scores (0-2) with 9.1% being asymptomatic (MRS 0). At follow-up time, the percentage of patients in a good MRS grade(1-2) was 90.7% with a percentage of 52.3% asymptomatic patients. Short and long-term outcome was significantly correlated with admission H&H grade (p<0.0001 and p=0.013, respectively).


This study provides evidence that patients with nonaneurysmal SAH have an uncomplicated course and a particularly favorable outcome. The lack of false-negative results in the first angiography of these patients indicates that with the use of modern DSA techniques and in experienced hands, repeat angiographic investigations may not be warranted.