Abstract
BackgroundUp to 15% of all spontaneous subarachnoid hemorrhages (SAH) have a non-aneurysmal SAH (NASAH). The evaluation of SAH patients with negative digital subtraction angiography (DSA) is sometimes a diagnostic challenge. Our goal in this study was to reassess the yield of standard MR-imaging of the complete spinal axis to rule out spinal bleeding sources in patients with NASAH.MethodsWe retrospectively analyzed the spinal MRI findings in 190 patients with spontaneous NASAH, containing perimesencephalic (PM) and non-perimesencephalic (NPM) SAH, diagnosed by computer tomography (CT) and/or lumbar puncture (LP), and negative 2nd DSA.Results190 NASAH patients were included in the study, divided into PM-SAH (n = 87; 46%) and NPM-SAH (n = 103; 54%). Overall, 23 (22%) patients had a CT negative SAH, diagnosed by positive LP. MR-imaging of the spinal axis detected two patients with lumbar ependymoma (n = 2; 1,05%). Both patients complained of radicular sciatic pain. The detection rate raised up to 25%, if only patients with radicular sciatic pain received an MRI.ConclusionRoutine radiological investigation of the complete spinal axis in NASAH patients is expensive and can not be recommended for standard procedure. However, patients with clinical signs of low-back/sciatic pain should be worked up for a spinal pathology.
Highlights
Subarachnoid hemorrhage (SAH) is normally due to intracranial lesions, mostly aneurysms or vascular malformations
190 non-aneurysmal SAH (NASAH) patients were included in the study, divided into PM-subarachnoid hemorrhages (SAH) (n = 87; 46%) and NPM-SAH (n = 103; 54%)
We investigated the yield of clinical and radiological characteristics in 190 patients with subsequent diagnosis of spontaneous NASAH with headache as leading symptom, based on hemorrhage pattern on computer tomography (CT), or a positive lumbar puncture (LP), and no identifiable intracranial vascular pathology on cerebral digital subtraction angiography (DSA)
Summary
Subarachnoid hemorrhage (SAH) is normally due to intracranial lesions, mostly aneurysms or vascular malformations. Published data showed increasing numbers of patients with non-aneurysmal SAH (NASAH) [2]. The evaluation of patients with subarachnoid hemorrhage with negative digital subtraction angiography (DSA) is important and sometimes a diagnostic challenge. Additional investigations to definitively detect an intracranial cause of the hemorrhage and to assess the course of the disease, treatment options and prognosis, such as repeat digital subtraction angiography (DSA) or CT angiography (CT-A), are especially recommended in NPM-SAH patients [5,6,7,8,9]. Up to 15% of all spontaneous subarachnoid hemorrhages (SAH) have a non-aneurysmal SAH (NASAH). The evaluation of SAH patients with negative digital subtraction angiography (DSA) is sometimes a diagnostic challenge.
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