Neurological Surgery No Shinkei Geka Volume 22, Issue 1 (January 1994)

Management for Subarachnoid Hemorrhage with Negative Initial Angiography Yoji KOMATSU 1 , Susumu YASUDA 1 , Tomoyuki SHIBATA 1 , Yukio ONO 1 , Akio HYODO 2 , Tadao NOSE 2 1Department of Neurosurgery, Kensei General Hospital 2Department of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba Keyword: Subarachnoid hemorrhage , Unknown etiology , Occult aneurysm pp.43-49
Published Date 1994/1/10
  • Abstract
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Subarachnoid hemorrhage (SAH) is commonly caused by ruptured aneurysm or arteriovenous mal-formation which is detected by cerebral angiogram. However, since angiograms sometimes cannot show the origin of SAH, we review 12 cases (6.3% of total SAH) to assess the management of these cases.

We divided the 12 cases into three groups. Group A (occulted aneurysm group) consisted of six cases of which aneurysms were detected by repeated angio-graphies in four, and by surgical procedures in two. Group U (unknown etiology group) consisted of five cases. Their follow up periods varied from 7 months to 7 years 11 months, and all of them recovered well and had no episode of rebleeding. Group R (rebleeding group) consisted of one case which fatally re-bled on the second day.

Group A tended to be Hunt and Hess grade 3, and Fisher group 3 or 4. In contrast, group U tended to be H and H grade 1 or 2, and Fisher group 2. However by their clinical and neuroradiological findings alone, it was not possible to distinguish the two groups certain-ly. This means that the patients whose initial angiogra-phy does not show the origin of bleeding must be cared for as an occult aneurysm case. Twice repeated angio-grams should be programmed. In our cases the first was carried out on the seventh day in the hope that the reason for vasospasm of the parent artery might be shown to be a hidden aneurysm. The second was car-ried out sometime between the 14th and 21st day be-cause of thrombolysis in the aneurysm, and because it was necessary to relieve vasospasm. The occulted aneurysm is commonly sited on the anterior communicating artery or in the posterior cir-culation of the Willis ring.

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Neurological Surgery 脳神経外科
22巻1号 (1994年1月)
電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院