Nonaneurysmal nonperimesencephalic subarachnoid hemorrhage: is it a benign entity?

• Published in: Surgical neurology Vol. 71; no. 5; pp. 566 - 571
• Main Authors: Gupta, Sunil K., MCh, Gupta, Rahul, MCh, Khosla, Virender K., MCh, Mohindra, Sandeep, MCh, Chhabra, Rajesh, MCh, Khandelwal, Niranjan, MD, Gupta, Vivek, MD, Mukherjee, Kanchan K., MCh, Tewari, Manoj K., MCh, Pathak, Ashish, MCh, Mathuriya, Suresh N., MCh
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2009
• Subjects: Adult; Aged; Brain - diagnostic imaging; Brain - pathology; Brain - physiopathology; Calcium Channel Blockers - therapeutic use; Cerebral Angiography; Cerebral Arteries - pathology; Cerebral Arteries - physiopathology; Female; Humans; Male; Mesencephalon - blood supply; Mesencephalon - diagnostic imaging; Mesencephalon - pathology; Middle Aged; Mortality; Negative angiography; Neurology; Nonperimesencephalic hemorrhage; Perimesencephalic hemorrhage; Postoperative Care - methods; Postoperative Care - standards; Postoperative Hemorrhage - diagnostic imaging; Postoperative Hemorrhage - pathology; Postoperative Hemorrhage - prevention & control; Predictive Value of Tests; Prognosis; Prospective Studies; Secondary Prevention; Subarachnoid hemorrhage; Subarachnoid Hemorrhage - diagnostic imaging; Subarachnoid Hemorrhage - mortality; Subarachnoid Hemorrhage - pathology; Subarachnoid Space - diagnostic imaging; Subarachnoid Space - pathology; Subarachnoid Space - physiopathology; Surgery; Surgical Instruments; Tomography, X-Ray Computed; Vascular Surgical Procedures - instrumentation; Vascular Surgical Procedures - methods; Perimesencephalic hemorrhage; computed tomographic angiogram; n-PMN SAH; digital subtraction angiography; GOS; MCA; H&H; middle cerebral artery; nonperimesencephalic subarachnoid hemorrhage; CTA; DSA; perimesencephalic subarachnoid hemorrhage; Nonperimesencephalic hemorrhage; Negative angiography; subarachnoid hemorrhage; PMN SAH; SAH; Glasgow outcome score; Hunt and Hess; COPD; chronic obstructive pulmonary disease; Subarachnoid hemorrhage
• ISSN: 0090-3019; 1879-3339
• DOI: 10.1016/j.surneu.2008.04.021

Abstract Background Although the clinical profile of patients with PMN SAH is well documented, there are scarce data available for patients with nonaneurysmal n-PMN SAH. In the present study, the clinical characteristics of patients with n-PMN SAH were analyzed and compared with those of PMN SAH and aneurysmal SAH. Methods Patients with spontaneous SAH, in whom the initial DSA or 3-dimensional CTA result was normal, underwent another investigation (CTA/DSA). If the results of both of these were negative, a second DSA was done after 4 to 6 weeks. Patients in whom even the second DSA failed to reveal an aneurysm or any other vascular abnormality were labeled as nonaneurysmal SAH. Within this group, 2 different types were identified: PMN SAH and n-PMN SAH. Results There were 61 patients in whom the results of the first DSA and CTA were both negative. In 2 of these patients, an aneurysm was demonstrated at a second DSA. Seven patients died before a second DSA could be done. After excluding these, there were 18 patients with PMN SAH and 34 with n-PMN SAH. There was no mortality in these patients; and at a mean follow-up of 1.8 years, all patients with PMN SAH and 94.1% of patients with n-PMN SAH had a good outcome. Associated comorbid illnesses were more frequent in patients with PMN SAH and n-PMN SAH as compared with the aneurysmal SAH patients. Conclusions Once an aneurysm is definitely excluded, patients with n-PMN SAH have a good outcome, and like PMN SAH, have a benign clinical course. However, a second DSA is mandatory to avoid missing an aneurysm or any other vascular lesion.