The Prevalence of Cerebrovascular Abnormalities Detected in Various Diagnostic Subgroups of Spontaneous Subarachnoid Hemorrhage in the Modern Era

To determine prevalence of cerebrovascular abnormalities in diagnostic subgroups of spontaneous subarachnoid hemorrhage (SAH) in a regional neurosurgical center in the modern era. Data of 609 consecutive patients with spontaneous SAH in a 3-year period (August 2010 to August 2013) were prospectively...

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Bibliographic Details
Published in:World neurosurgery 2018-03, Vol.111, p.e355-e361
Main Authors: Chong, Ming Y., Martin, Sean C., Phang, Isaac, St George, E.J., Suttner, Nigel, Teo, Mario K.
Format: Article
Language:English
Subjects:
Adult
Aged
Female
Humans
Intracranial Arteriovenous Malformations - complications
Intracranial Arteriovenous Malformations - diagnostic imaging
Intracranial Arteriovenous Malformations - epidemiology
Male
Middle Aged
Prevalence
Prospective Studies
Subarachnoid hemorrhage
Subarachnoid Hemorrhage - etiology
Tomography, X-Ray Computed
Vascular abnormalities
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Summary:To determine prevalence of cerebrovascular abnormalities in diagnostic subgroups of spontaneous subarachnoid hemorrhage (SAH) in a regional neurosurgical center in the modern era. Data of 609 consecutive patients with spontaneous SAH in a 3-year period (August 2010 to August 2013) were prospectively collected. Patients were divided into 3 diagnostic subgroups: computed tomography (CT) positive for SAH; CT negative but positive cerebrospinal fluid examination by spectrophotometry for SAH; CT negative for SAH and inconclusive cerebrospinal fluid examination. All patients fit for intervention underwent CT angiography with or without digital subtraction angiography to identify vascular abnormalities for subsequent treatment. Of 609 patients, 554 were fit for further investigation and consideration of further intervention; 514 patients had confirmed SAH. Mean patient age was 54.0 years; 61.5% of patients were women. Of patients, 390 (75.9%) showed vascular abnormalities on angiography. There were 438 patients (85.2%) with confirmed SAH diagnosed on CT scan (group 1). Vascular abnormalities were detected in 81.1% of patients; 18.9% of patients with positive CT scan had no identifiable cause of SAH. Of patients with confirmed SAH, 76 (14.8%) had negative CT scan but positive lumbar puncture (group 2); 46.1% of patients in this group had vascular abnormalities. Three patients with inconclusive cerebrospinal fluid examination had lesions requiring treatment. Median length of hospital stay in group 1 patients was longer than median length of hospital stay in group 2 patients. Frequency of vascular abnormalities in spontaneous SAH is lower than the traditionally quoted figure, which has diagnostic and prognostic implications for patient management.
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2017.12.077