Volume 3, Issue 3 (12-2017)                   IrJNS 2017, 3(3): 95-102 | Back to browse issues page


XML Print


1- Department of Radiology, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
2- MD Department of Neurosurgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran , hafez125@gmail.com
3- Department of Neurosurgery, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
4- Department of Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
5- Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
6- Department of Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran, , Kermanshah University of Medical Sciences,
Abstract:   (649 Views)
Background and Aim: This study aimed at analyzing the demographic characteristics of the patients with non-traumatic intracranial hemorrhage, their angiographic results and the correlation between computed tomography (CT) scan and angiography findings.
Methods and Materials/Patients: In a descriptive study, we retrospectively reviewed the records of the patients with non-traumatic intracranial hemorrhage based on their brain CT or lumbar puncture findings from 2011 to 2017. For all patients, four vessel catheter angiography via the femoral approach was performed in the Medical Imaging Center of Kermanshah University of Medical Sciences, Iran.
Results: We investigated 143 cases with non-traumatic intracranial hemorrhage which was indicated in CT findings (91.61%) or lumbar puncture (8.39%). Of 143 patients, 64 (44.8%) were men and 79 (55.2%) women (mean age 53.7±12.1 years old). Moreover, 104(72.7%) patients had Subarachnoid Hemorrhage (SAH), 19(13.3%) of them had Intracranial Hemorrhage (ICH), 8(5.6%) ones had Intraventricular Hemorrhage (IVH) and 12(8.4%) patients had normal brain CT. There were 100 cases of aneurysm (69.93%), 13 cases of Arteriovenous Malformations (AVM) (9.09%), 28 cases with negative angiograms (19.58%), and 2 cases with other pathologies (1.4%). Seven (4.89%) cases of multiple aneurysms were also recorded. Of 13 patients with AVM, 8(61.5%) patients had AVM in parieto-occipital region, 2(15.4%) in temporal, 1(7.7%) in frontal region and 2(15.4%) had deep AVM. Two (1.4%) patients with SAH had dural AVF. Twenty-eight (19.6%) patients had negative angiogram, 22 cases of them had second angiography after one to two weeks. The most common positive finding in the second angiogram was Acom aneurysm (18.18%).
Conclusion: Aneurysms and AVMs are the most common causes of non-traumatic intracranial hemorrhage. The most common site of intracranial aneurysms is the circle of Willis. A second angiogram after one to two weeks is necessary in most patients with negative results in first angiography after non-traumatic intracranial hemorrhage.
Full Text [PDF 852 kb]   (212 Downloads) |   |   Full Text (HTML)  (122 Views)  
Type of Study: Research |
* Corresponding Author Address: Department of Neurosurgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

References
1. Ahn SY, Lim DJ, Kim SH, Kim SD, Hong KS, Ha SK. Clinical analysis of patients with spontaneous subarachnoid hemorrhage of initial negative angiography. Korean Journal of Cerebrovascular Surgery. 2011; 13(3):230-4.
2. Alén JF, Lagares A, Campollo J, Ballenilla F, Kaen A, Nú-ez ÁP, et al. Idiopathic subarachnoid hemorrhage and venous drainage: Are they related? Neurosurgery. 2008; 63(6):1106-12. doi: 10.1227/01.neu.0000335777.14055.71 [DOI:10.1227/01.NEU.0000335777.14055.71]
3. Almandoz JED, Jagadeesan BD, Refai D, Moran CJ, Cross III DT, Chicoine MR, et al. Diagnostic yield of repeat catheter angiography in patients with catheter and computed tomography angiography negative subarachnoid hemorrhage. Neurosurgery. 2012; 70(5):1135-42. doi: 10.1227/neu.0b013e318242575e [DOI:10.1227/NEU.0b013e318242575e]
4. Boswell S, Thorell W, Gogela S, Lyden E, Surdell D. Angiogram-negative subarachnoid hemorrhage: outcomes data and review of the literature. Journal of Stroke and Cerebrovascular Diseases. 2013; 22(6):750-7. doi: 10.1016/j.jstrokecerebrovasdis.2012.02.001 [DOI:10.1016/j.jstrokecerebrovasdis.2012.02.001]
5. Canneti B, Mosqueira AJ, Nombela F, Gilo F, Vivancos J. Spontaneous subarachnoid hemorrhage with negative angiography managed in a stroke unit: Clinical and prognostic characteristics. Journal of Stroke and Cerebrovascular Diseases. 2015; 24(11):2484-90. doi: 10.1016/j.jstrokecerebrovasdis.2015.06.011 [DOI:10.1016/j.jstrokecerebrovasdis.2015.06.011]
6. Cánovas D, Gil A, Jato M, de Miquel M, Rubio F. Clinical outcome of spontaneous non‐aneurysmal subarachnoid hemorrhage in 108 patients. European Journal of Neurology. 2012; 19(3):457-61. doi: 10.1111/j.1468-1331.2011.03542.x [DOI:10.1111/j.1468-1331.2011.03542.x]
7. Connors JL, Wojak J. Intracranial aneurysms; general considerations. In: Connors JL, Wojak JC, editors. Interventional Neuroradiology. Philadelphia: WB Saunders. 1998.
8. De Oliveira Manoel AL, Turkel-Parrella D, Germans M, Kouzmina E, da Silva Almendra P, Marotta T, et al. Safety of early pharmacological thromboprophylaxis after subarachnoid hemorrhage. The Canadian Journal of Neurological Sciences. 2014; 41(05):554-61. doi: 10.1017/cjn.2014.16 [DOI:10.1017/cjn.2014.16]
9. Dupont SA, Lanzino G, Wijdicks EF, Rabinstein AA. The use of clinical and routine imaging data to differentiate between aneurysmal and nonaneurysmal subarachnoid hemorrhage prior to angiography: Clinical article. Journal of Neurosurgery. 2010; 113(4):790-4. doi: 10.3171/2010.4.jns091932 [DOI:10.3171/2010.4.JNS091932]
10. El Khaldi M, Pernter P, Ferro F, Alfieri A, Decaminada N, Naibo L, et al. Detection of cerebral aneurysms in nontraumatic subarachnoid haemorrhage: Role of multislice CT angiography in 130 consecutive patients. La radiologia medica. 2007; 112(1):123-37. doi: 10.1007/s11547-007-0126-8 [DOI:10.1007/s11547-007-0126-8]
11. Elhadi AM, Zabramski JM, Almefty KK, Mendes GA, Nakaji P, McDougall CG, et al. Spontaneous subarachnoid hemorrhage of unknown origin: hospital course and long-term clinical and angiographic follow-up. Journal of Neurosurgery. 2015; 122(3):663-70. doi: 10.3171/2014.10.jns14175 [DOI:10.3171/2014.10.JNS14175]
12. Flaherty ML, Haverbusch M, Kissela B, Kleindorfer D, Schneider A, Sekar P, et al. Perimesencephalic subarachnoid hemorrhage: incidence, risk factors, and outcome. Journal of Stroke and Cerebrovascular Diseases. 2005; 14(6):267-71. doi: 10.1016/j.jstrokecerebrovasdis.2005.07.004 [DOI:10.1016/j.jstrokecerebrovasdis.2005.07.004]
13. Zhao J, Lin H, Summers R, Yang M, Cousins BG, Tsui J. Current treatment strategies for intracranial aneurysms: An overview. Angiology. 2017; 69(1):17-30. doi: 10.1177/0003319717700503 [DOI:10.1177/0003319717700503]
14. Fontanella M, Rainero I, Panciani PP, Schatlo B, Benevello C, Garbossa D, et al. Subarachnoid hemorrhage and negative angiography: Clinical course and long-term follow-up. Neurosurgical Review. 2011; 34(4):477-84. doi: 10.1007/s10143-011-0323-8 [DOI:10.1007/s10143-011-0323-8]
15. Halpin S, Britton J, Byrne J, Clifton A, Hart G, Moore A. Prospective evaluation of cerebral angiography and computed tomography in cerebral haematoma. Journal of Neurology, Neurosurgery & Psychiatry. 1994; 57(10):1180-6. doi: 10.1136/jnnp.57.10.1180 [DOI:10.1136/jnnp.57.10.1180]
16. Huttner H, Hartmann M, Köhrmann M, Neher M, Stippich C, Hähnel S, et al. Repeated digital substraction angiography after perimesencephalic subarachnoid hemorrhage? Journal of Neuroradiology. 2006; 33(2):87-9. doi: 10.1016/s0150-9861(06)77236-4 [DOI:10.1016/S0150-9861(06)77236-4]
17. Ildan F, Tuna M, Erman T, Göçer AI, Çetinalp E, Burgut R. Prognosis and prognostic factors for unexplained subarachnoid hemorrhage: review of 84 cases. Neurosurgery. 2002; 50(5):1015-25. doi: 10.1227/00006123-200205000-00015 [DOI:10.1227/00006123-200205000-00015]
18. Inamasu J, Nakamura Y, Saito R, Horiguchi T, Kuroshima Y, Mayanagi K, et al. "Occult" ruptured cerebral aneurysms revealed by repeat angiography: result from a large retrospective study. Clinical Neurology and Neurosurgery. 2003; 106(1):33-7. doi: 10.1016/j.clineuro.2003.09.002 [DOI:10.1016/j.clineuro.2003.09.002]
19. Ishihara H, Kato S, Akimura T, Suehiro E, Oku T, Suzuki M. Angiogram-negative subarachnoid hemorrhage in the era of three dimensional rotational angiography. Journal of Clinical Neuroscience. 2007; 14(3):252-5. doi: 10.1016/j.jocn.2006.01.011 [DOI:10.1016/j.jocn.2006.01.011]
20. Jung JY, Kim YB, Lee JW, Huh SK, Lee KC. Spontaneous subarachnoid haemorrhage with negative initial angiography: A review of 143 cases. Journal of Clinical Neuroscience. 2006; 13(10):1011-7. doi: 10.1016/j.jocn.2005.09.007 [DOI:10.1016/j.jocn.2005.09.007]
21. Kaim A, Proske M, Kirsch E, Weymarn Av, Radü EW, Steinbrich W. Value of repeat‐angiography in cases of unexplained Subarachnoid Hemorrhage (SAH). Acta Neurologica Scandinavica. 1996; 93(5):366-73. doi: 10.1111/j.1600-0404.1996.tb00011.x [DOI:10.1111/j.1600-0404.1996.tb00011.x]
22. Karttunen A, Jartti P, Ukkola V, Sajanti J, Haapea M. Value of the quantity and distribution of subarachnoid haemorrhage on CT in the localization of a ruptured cerebral aneurysm. Acta Neurochirurgica. 2003; 145(8):655-61. doi: 10.1007/s00701-003-0080-8 [DOI:10.1007/s00701-003-0080-8]
23. Kaufmann TJ, Huston III J, Mandrekar JN, Schleck CD, Thielen KR, Kallmes DF. Complications of diagnostic cerebral angiography: Evaluation of 19 826 consecutive patients 1. Radiology. 2007; 243(3):812-9. doi: 10.1148/radiol.2433060536 [DOI:10.1148/radiol.2433060536]
24. Khan A, Smith JS, Kirkman M, Robertson F, Wong K, Dott C, et al. Angiogram negative subarachnoid haemorrhage: outcomes and the role of repeat angiography. Clinical Neurology and Neurosurgery. 2013; 115(8):1470-5. doi: /10.1016/j.clineuro.2013.02.002
25. Kitkhuandee A, Thammaroj J, Munkong W, Duangthongpon P, Thanapaisal C. Cerebral angiographic findings in patients with non-traumatic subarachnoid hemorrhage. Journal of the Medical Association of Thailand. 2012; 95(11):S121-S9. PMID: 23961631 [PMID]
26. Konczalla J, Schmitz J, Kashefiolasl S, Senft C, Seifert V, Platz J. Non‐aneurysmal subarachnoid hemorrhage in 173 patients: a prospective study of long‐term outcome. European Journal of Neurology. 2015; 22(10):1329-36. doi: 10.1111/ene.12762 [DOI:10.1111/ene.12762]
27. Bhogal P, AlMatter M, Hellstern V, et al. Difference in aneurysm characteristics between ruptured and unruptured aneurysms in patients with multiple intracranial aneurysms. Surgical Neurology International. 2018;9:(1)1. doi: 10.4103/sni.sni_339_17 [DOI:10.4103/sni.sni_339_17]
28. Korja M, Silventoinen K, Laatikainen T, Jousilahti P, Salomaa V, Hernesniemi J, et al. Risk factors and their combined effects on the incidence rate of subarachnoid hemorrhage–a population-based cohort study. PLoS One. 2013;8(9):e73760. doi: 10.1371/journal.pone.0073760 [DOI:10.1371/journal.pone.0073760]
29. Little AS, Garrett M, Germain R, Farhataziz N, Albuquerque FC, McDougall CG, et al. Evaluation of patients with spontaneous subarachnoid hemorrhage and negative angiography. Neurosurgery. 2007; 61(6):1139-51. doi: 10.1227/01.neu.0000306091.30517.e7 [DOI:10.1227/01.neu.0000306091.30517.e7]
30. Moran CJ. Aneurysmal subarachnoid hemorrhage: DSA versus CT angiography—is the answer available? Radiology. 2011; 258(1):15-7. doi: 10.1148/radiol.101911 [DOI:10.1148/radiol.101911]
31. Prestigiacomo CJ, Sabit A, He W, Jethwa P, Gandhi C, Russin J. Three dimensional CT angiography versus digital subtraction angiography in the detection of intracranial aneurysms in subarachnoid hemorrhage. Journal of NeuroInterventional Surgery. 2010; 2(4):385-9. doi: 10.1136/jnis.2010.002246 [DOI:10.1136/jnis.2010.002246]
32. Sarabia R, Lagares A, Fernández-Alén J, Arikan F, Vilalta J, Ibá-ez J, et al. Idiopathic subarachnoid hemorrhage: a multicentre series of 220 patients. Neurocirugía. 2010; 21(6):441-51. doi: 10.1016/s1130-1473(10)70094-4 [DOI:10.1016/S1130-1473(10)70094-4]
33. Suarez JI, Tarr RW, Selman WR. Aneurysmal subarachnoid hemorrhage. New England Journal of Medicine. 2006; 354(4):387-96. doi: 10.1056/nejmra052732 [DOI:10.1056/NEJMra052732]
34. Topcuoglu MA, Ogilvy CS, Carter BS, Buonanno FS, Koroshetz WJ, Singhal AB. Subarachnoid hemorrhage without evident cause on initial angiography studies: diagnostic yield of subsequent angiography and other neuroimaging tests. Journal of Neurosurgery. 2003; 98(6):1235-40. doi: 10.3171/jns.2003.98.6.1235 [DOI:10.3171/jns.2003.98.6.1235]
35. Vaitkevicius G, Gvazdaitis A, Lukosevicius S. [Spontaneous subarachnoid hemorrhage: Patients' examination after aneurysm-negative initial angiograms (Lithuanian)]. Medicina (Kaunas, Lithuania). 2001; 38(10):976-81. doi: PMID: 12532705
36. Hammer A, Steiner A, Kerry G, et al. Treatment of ruptured intracranial aneurysms yesterday and now. PLoS ONE. 2017;12(3):e0172837. doi: 10.1371/journal.pone.0172837 [DOI:10.1371/journal.pone.0172837]
37. Van Gijn J, Rinkel G. Subarachnoid haemorrhage: Diagnosis, causes and management. Brain. 2001; 124(2):249-78. doi: 10.1093/brain/124.2.249 [DOI:10.1093/brain/124.2.249]
38. Vega C, Kwoon JV, Lavine SD. Intracranial aneurysms: current evidence and clinical practice. American Family Physician. 2002; 66(4):601-8. PMID: 12201551 [PMID]
39. Vivancos J, Gilo F, Frutos R, Maestre J, García-Pastor A, Quintana F, et al. Clinical management guidelines for subarachnoid haemorrhage. Diagnosis and treatment. Neurología (English Edition). 2014; 29(6):353-70. doi: 10.1016/j.nrl.2012.07.009. [DOI:10.1016/j.nrl.2012.07.009]
40. Willinsky RA, Taylor SM, TerBrugge K, Farb RI, Tomlinson G, Montanera W. Neurologic complications of cerebral angiography: prospective analysis of 2,899 procedures and review of the literature 1. Radiology. 2003; 227(2):522-8. doi: 10.1148/radiol.2272012071 [DOI:10.1148/radiol.2272012071]
41. Yu DW, Jung YJ, Choi BY, Chang CH. Subarachnoid hemorrhage with negative baseline digital subtraction angiography: is repeat digital subtraction angiography necessary? Journal of Cerebrovascular and Endovascular Neurosurgery. 2012; 14(3):210-5. doi: 10.7461/jcen.2012.14.3.210 [DOI:10.7461/jcen.2012.14.3.210]
42. Zhu X, Chan M, Poon W. Spontaneous intracranial hemorrhage: which patients need diagnostic cerebral angiography? Stroke. 1997; 28(7):1406-9. doi: 10.1161/01.str.28.7.1406 [DOI:10.1161/01.STR.28.7.1406]
43. Firouznia K, Ghaanati H, Shabani Sm, Shakiba M. Subarachnoid hemorrhage; An an-giographic evaluation in Iran. Iranian Journal of Radiology. 2004; 2(1-2):28-33.