caa a22 4500 606214194 CHVBK 20210128101051.0 cr unu---uuuuu 210128e20150901xx s 000 0 eng 10.1007/s00701-015-2506-5 doi (NATIONALLICENCE)springer-10.1007/s00701-015-2506-5 Spontaneous subarachnoid hemorrhage and negative initial vascular imaging—should further investigation depend upon the pattern of hemorrhage on the presenting CT? [Elektronische Daten] [L. Yap, R. Dyde, T. Hodgson, U. Patel, S. Coley] Background: Multiple investigations are usually performed in patients with spontaneous SAH who have negative initial angiography. This study aimed to evaluate the most appropriate use of additional imaging studies and how this may be influenced by the findings of the initial CT. Methods: A retrospective analysis was performed on a prospectively collected cohort of patients referred with spontaneous SAH and negative initial angiography. The patients were divided into four categories based upon the distribution of blood on the initial CT: perimesencephalic (pSAH), diffuse (dSAH), sulcal (sSAH) and CT negative (CSF positive for xanthochromia) (nCT-pLP). The number and nature of the subsequent imaging investigations were reviewed, and the results were correlated with the findings of the presenting CT. Results: One hundred fourteen patients were included in the study. Repeat imaging found five relevant abnormalities. Three cases of vasculitis were diagnosed on the first DSA following a negative CTA. A case of dissecting aneurysm was revealed on the third neurovascular study. A hemorrhagic spinal tumor presented with xanthochromia. No subsequent abnormality was found on the third DSA or MRI head. No case of pSAH had a subsequent positive finding if the initial CTA was negative. Conclusions: Certain patterns of SAH are associated with a low yield of abnormalities on repeat imaging if the initial angiography is normal. The authors believe that the pattern of hemorrhage on the presenting CT should be used to guide the most appropriate use of further imaging modalities and present a diagnostic algorithm for this purpose. Springer-Verlag Wien, 2015 Subarachnoid hemorrhage nationallicence Perimesencephalic nationallicence Diffuse nationallicence Sulcal nationallicence Angiography nationallicence Yap L. Department of Neuroradiology, Royal Hallamshire Hospital, Glossop Road, S10 2JF, Sheffield, UK aut Dyde R. Department of Neuroradiology, Royal Hallamshire Hospital, Glossop Road, S10 2JF, Sheffield, UK aut Hodgson T. Department of Neuroradiology, Royal Hallamshire Hospital, Glossop Road, S10 2JF, Sheffield, UK aut Patel U. Department of Neurosurgery, Royal Hallamshire Hospital, Glossop Road, S10 2JF, Sheffield, UK aut Coley S. Department of Neuroradiology, Royal Hallamshire Hospital, Glossop Road, S10 2JF, Sheffield, UK aut Acta Neurochirurgica Springer Vienna 157/9(2015-09-01), 1477-1484 0001-6268 157:9<1477 2015 157 701 https://doi.org/10.1007/s00701-015-2506-5 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00701-015-2506-5 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Yap L. Department of Neuroradiology, Royal Hallamshire Hospital, Glossop Road, S10 2JF, Sheffield, UK aut NATIONALLICENCE 700 1- Dyde R. Department of Neuroradiology, Royal Hallamshire Hospital, Glossop Road, S10 2JF, Sheffield, UK aut NATIONALLICENCE 700 1- Hodgson T. Department of Neuroradiology, Royal Hallamshire Hospital, Glossop Road, S10 2JF, Sheffield, UK aut NATIONALLICENCE 700 1- Patel U. Department of Neurosurgery, Royal Hallamshire Hospital, Glossop Road, S10 2JF, Sheffield, UK aut NATIONALLICENCE 700 1- Coley S. Department of Neuroradiology, Royal Hallamshire Hospital, Glossop Road, S10 2JF, Sheffield, UK aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer Vienna 157/9(2015-09-01), 1477-1484 0001-6268 157:9<1477 2015 157 701