Posted by: arisfil | February 12, 2008

Subarachnoid Hemorrhage and negative angiography

Neurosurgery Journal  Neurosurgery. 2007 Dec;61(6):1139-50; discussion 1150-1

Neurosurgery journal in its December 2007 issue, hosts an article about spontaneous SAH and negative angiography by Dr Little et al, at Barrow Neurosurgical Institute, Phoenix, Arizona. The authors retrospectively studied 100 patients with spontaneous SAH and negative angiographies. A cause was determined in 13 patients (13%), with aneurysm finding in 7 patients. They state that repeat angio was the most useful in detecting the lesions. The second angio scored best when a classic hemorrhagic pattern was met. Five patients with thrombosed aneurysms were not detected with first angio. One cervical ependymoma was found using spinal MRI and other factors, like antiplatelet therapy and drug use were found in 13 patients.

The authors finally propose three new diagnostic algorithms concerning the SAH with negative angiography, based on their findings.

My comment: 

SAH and negative angiography is a differential diagnostic problem that its solution is imperative since the possibility of hemorrhage recurrence could be disastrous. The authors provide us with useful algorithms that interpret findings in the literature and try to solve diagnostic problems and precede unfortunate outcomes.Your comments would create an intriguing discussion thread. 

This article is under the copyright © of Dr Little et al and Congress of Neurological Surgeons. All rights reserved.

Neurosurgery is published by Lippincott Williams & Wilkins.

 GOOGLE GROUPS Encephalos Discussion Thread: click 



  1. When looking for SAH, Angio is not the modality of choice. MRI of the brain with Hemosiderin scans are by far more sensitive to blood than an MRA.
    I would do The MRA in conjunction with the MRI of the brain. and possiblly an MRA of the carotids for vertebral Disection. Just my opionion.

  2. Do you feel that MRA in conjunction to brain MRI with hemosiderin scans is superior to the classic Digital Subtraction Angiography ?

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