Subarachnoid hemorrhage: utility of cerebral catheter angiogram in patients with abnormal and normal CT

Abstract

Purpose: To determine the relationship between the presence and location of acute nontraumatic subarachnoid hemorrhage (SAH) demonstrated by CT/lumbar puncture with the results of cerebral catheter angiography. Materials and methods: We identified all patients admitted to the emergency room with the diagnosis of acute nontraumatic SAH during a 5-year period. We reviewed the CT studies for presence or absence of SAH and noted SAH location as follows: mostly perimesencephalic, suprasellar, left sylvian fissure, right sylvian fissure, interhemispheric fissure, cortical sulci in convexities, diffuse, and intraventricular. The results of cerebral catheter angiography and lumbar puncture were also reviewed. Results: Of 239 patients admitted with the diagnosis of acute nontraumatic SAH, 43 had negative catheter cerebral angiograms. In these patients, CT was abnormal in 35 with the SAH located as follows: only perimesencephalic (n = 10), suprasellar (n = 7), left sylvian fissure (n = 7), right sylvian fissure (n = 5), interhemispheric fissure (n = 5), cortical sulci in convexities (n = 6), diffuse (n = 5), and intraventricular (n = 9). In 8 patients, CT was normal. All patients had xanthochromia in their cerebrospinal fluid. Conclusion: In our patients with acute nontraumatic SAH and negative cerebral catheter angiograms, CT studies showed perimesencephalic blood in 10 and were normal in 8. Emergency catheter cerebral angiography is probably not needed in these patients and MR angiography may be sufficient to evaluate the major intracranial arteries. In patients with SAH and blood in other locations by CT, catheter cerebral angiography should be performed.