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Subarachnoid haemorrhage of unknown aetiology

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Summary

The authors review the literature on subarachnoid haemorrhage of unknown aetiology (SAHUE) and analyze a personal series of 212 patients diagnosed as SAHUE. These patients represent 30% of all cases of primary SAH admitted over a 14.5 year period.

The age, sex, antecedents and initial clinical presentation of patients with SAHUE were indistinguishable from those of patients with subarachnoid haemorrhage due to ruptured aneurysm (SAHRA). However, the present series of SAHUE compare favourably with both a personal and a previously reported series of SAHRA insofar as clinical grade on admission (94% of patients in grades I–II of Botterell), presence of blood on CT (51%), vasospasm (5%), ischaemic deficits (3.3%), persistent hydrocephalus (3.5%), rebleeding (6%) and fatal result (3.9%) are concerned.

The amount of blood on CT scan in our patients with SAHUE was associated with a significantly higher incidence of brain ischaemia and hydrocephalus but did not correlate with the Botterell grade on admission or final outcome, which were good in the majority of cases regardless of the presence or not of visible cisternal haemorrhage. The results of the present series confirm that the final prognosis of patients with primary SAH showing normal four-vessel cerebral angiography is essentially favourable.

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References

  1. Adams HP Jr, Kassell NE, Torner JC, Sans AL (1983) CT and clinical correlations in recent aneurysmal subarachnoid hemorrhage: a preliminary report of the Cooperative Aneurysm Study. Neurology 33: 981–988

    PubMed  Google Scholar 

  2. Alexander MSM, Dias PS, Uttley D (1986) Spontaneous subarachnoid hemorrhage and negative panangiography: review of 149 cases. Neurosurgery 64: 537–542

    Google Scholar 

  3. Allcock TM, Drake CC (1965) Ruptured intracranial aneurysms—the role of arterial spasm. J Neurosurg 22: 21–29

    PubMed  Google Scholar 

  4. Andrioli GC, Salar G, Rigobello L, Mingrino S (1979) Subarachnoid hemorrhage of unknown etiology. Acta Neurochir (Wien) 48: 217–221

    Google Scholar 

  5. Barlow P (1985) Incidence of delayed cerebral ischemia following subarachnoid hemorrhage of unknown cause. J Neurol Neurosurg Psychiatry 48: 132–136

    PubMed  Google Scholar 

  6. Barraclough CR (1982) The incidence of radiologically demonstrable aneurysm and arteriovenous malformation in spontaneous subarachnoid hemorrhage. Postgrad Med J 58: 74–76

    PubMed  Google Scholar 

  7. Beguelin C, Seiler R (1983) Subarachnoid hemorrhage with normal cerebral panangiography. Neurosurgery 13: 409–411

    PubMed  Google Scholar 

  8. Björkensten G, Troup H (1957) Prognosis of subarachnoid hemorrhage. A comparison between patients with verified aneurysms and patients with normal angiograms. J Neurosurg 14: 434–441

    PubMed  Google Scholar 

  9. Botterell EH, Lougheed WM, Scott JW, Vanderwater SL (1956) Hypothermia and interruption of carotid, or carotid and vertebral circulation, in the surgical management of intracranial aneurysms. J Neurosurg 13: 1–42

    PubMed  Google Scholar 

  10. Brismar J, Sundbarg G (1985) Subarachnoid hemorrhage of unknown origin: prognosis and prognostic factors. J Neurosurg 63: 349–354

    PubMed  Google Scholar 

  11. du Boulay G (1963) Distribution of spasm in the intracranial arteries after subarachnoid hemorrhage. Acta Radiol (Diagn) 1: 257–266

    Google Scholar 

  12. Eskesen V, Sorensen EB, Rosenor J, Schmidt K (1984) The prognosis in subarachnoid hemorrhage of unknown etiology. J Neurosurg 61: 1029–1031

    PubMed  Google Scholar 

  13. Fisher CM, Kistler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6: 1–9

    PubMed  Google Scholar 

  14. Foster DMC, Steiner L, Hakanson S, Bergvall U (1978) The value of repeat panangiography in cases of unexplained subarachnoid hemorrhage. J Neurosurg 48: 712–716

    PubMed  Google Scholar 

  15. Giombini S, Bruzzone M, Pluchino F (1988) Subarachnoid hemorrhage of unexplained cause. Neurosurgery 22: 313–316

    PubMed  Google Scholar 

  16. Hayward RD (1977) Subarachnoid hemorrhage of unknown etiology. A clinical and radiological study of 51 cases. J Neurol Neurosurg Psychiatry 40: 926–931

    PubMed  Google Scholar 

  17. Hochberg FH, Fisher CM, Roberson GH (1974) Subarachnoid hemorrhage caused by rutpure of a small superficial artery. Neurology 24: 319–321

    PubMed  Google Scholar 

  18. Höök O (1958) Subarachnoid hemorrhage. Prognosis when angiography reveals no aneurysm. A report of 138 cases. Acta Med Scand 162: 493–503

    PubMed  Google Scholar 

  19. Jain VK, Hedge T, Easwaren RK, Das BS, Reddy GNN (1987) Benign subarachnoid hemorrhage (subarachnoid hemorrhage of unknown aetiology). Acta Neurochir (Wien) 86: 89–92

    Google Scholar 

  20. Jennet B, Bond M (1975) Assessment of outcome after severe brain damage. Lancet i: 480–484

    Google Scholar 

  21. Juul R, Frederiksen TA, Ringkjob R (1986) Prognosis in subarachnoid hemorrhage of unknown etiology. J Neurosurg 64: 359–362

    PubMed  Google Scholar 

  22. Kassell NF, Adams HP, Torner JC, Sahs AL (1981) Influence of timing of admission after aneurysmal subarachnoid hemorrhage on overall outcome. Report of the Cooperative Aneurysm Study. Stroke 12: 620–623

    PubMed  Google Scholar 

  23. Kassell NF, Haley EC, Torner JC (1986) Antifibrinolytic therapy in the treatment of aneurysmal subarachnoid hemorrhage. Clin Neurosurg 33: 137–145

    PubMed  Google Scholar 

  24. Kendall BE, Lee BCP, Claveria E (1976) Computerised tomography and angiography in subarachnoid hemorrhage. Br J Radiol 49: 483–501

    PubMed  Google Scholar 

  25. Kwak R, Niizuma H, Ohi T, Suzuki J (1979) Angiographic study in cerebral vasospasm following rupture of intracranial aneurysms: Part 1. Time of appearance. Surg Neurol 11: 257–262

    PubMed  Google Scholar 

  26. Levy LF (1960) Subarachnoid hemorrhage without arteriographie vascular abnormality. J Neurosurg 17: 252–258

    PubMed  Google Scholar 

  27. Margolis G, Odom GL, Woodhall B, Bloor BM (1951) The role of small angiomatous malformation in the production of intracerebral hematomas. J Neurosurg 8: 564–575

    PubMed  Google Scholar 

  28. Nishioka H, Torner JC, Graf CJ, Kassell NF, Sahs AC, Goettler LC (1984) Intracranial aneurysms and subarachnoid hemorrhage: long term prognostic study. III. Subarachnoid hemorrhage of undetermined etiology. Arch Neurol 41: 1147–1151

    PubMed  Google Scholar 

  29. Odom G (1968) Discussion in French LA, Chou SN, Long DM: The direct approach to intracranial aneurysms. Clin Neurosurg 15: 117–132

    PubMed  Google Scholar 

  30. Pakarinen S (1967) Incidence, aetiology, and prognosis of primary subarachnoid hemorrhage. A study base on 589 cases diagnosed in a defined urban population during a defined period. Acta Neurol Scand 43 [Suppl 29] 1–128

    Google Scholar 

  31. Pasqualin A, Rosta L, Da Pian R, Cavazzani P, Scienza R (1984) Role of computed tomography in the management of vasospasm after subarachnoid hemorrhage. Neurosurgery 15: 344–353

    PubMed  Google Scholar 

  32. Perret LV, Bull JWD (1959) Some aspects of subarachnoid hemorrhage: a symposium. III The accuracy of radiology in demonstrating ruptured intracranial aneurysms. Br J Radiol 32: 85–92

    PubMed  Google Scholar 

  33. Post KD, Flamm ES, Goodgold A, Ransohoff J (1977) Ruptured intracranial aneurysms. Case morbidity and mortality. J Neurosurg 46: 290–295

    PubMed  Google Scholar 

  34. Ropper AH, Zervas NT (1984) Outcome one year after SAH from cerebral aneurysm: management morbidity, mortality and functional status in 112 consecutive good-risk patients. J Neurosurg 60: 909–915

    PubMed  Google Scholar 

  35. Saito I, Shigeno T, Aritake K, Tanishima T, Sano K (1979) Vasospasm assessed by angiography and computerized tomography. J Neurosurg 51: 466–475

    PubMed  Google Scholar 

  36. Sakai N, Yamada H, Ando T, Nishimura Y (1985) Prevention of rebleeding after operation for subarachnoid hemorrhage of unknown cause. Neurosurgery 17: 942–946

    PubMed  Google Scholar 

  37. Sengupta RP, McAllister VL (1986) Subarachnoid hemorrhage. Springer, Berlin Heidelberg New York

    Google Scholar 

  38. Shephard RH (1984) Prognosis of spontaneous (non-traumatic) subarachnoid hemorrhage of unknown cause: a personal series 1958–1980. Lancet i: 777–778

    Google Scholar 

  39. Smith RR, Clower BR, Peeler DF, Yoshioka J (1983) The angiopathy of subarachnoid hemorrhage: angiographic and morphologic correlates. Stroke 14: 240–245

    PubMed  Google Scholar 

  40. Spallone A, Ferrante L, Palatinsky E, Santoro A, Acqui M (1986) Subarachnoid hemorrhage of unknown origin. Acta Neurochir (Wien) 80: 12–17

    Google Scholar 

  41. Spatz EL, Bull JWD (1957) Vertebral angiography in the study of subarachnoid hemorrhage. J Neurosurg 14: 543–547

    PubMed  Google Scholar 

  42. Standnes B, Heilo A (1980) Subarachnoid hemorrhage of unknown etiology. J Oslo City Hosp 30: 151–152

    PubMed  Google Scholar 

  43. Sundt TM Jr, Whisnant JP (1978) Subarachnoid hemorrhage from intracranial aneurysms. Surgical management and natural history of disease. N Eng J Med 299: 116–122

    Google Scholar 

  44. Suzuki S, Kayama T, Sakurai Y, Ogawa A, Suzuki J (1987) Subarachnoid hemorrhage of unknown cause. Neurosurgery 21: 310–313

    PubMed  Google Scholar 

  45. van Gijn, van Dongen KJ (1980) Computerized tomography in subarachnoid hemorrhage: difference between patients with and without an aneurysm on angiography. Neurology 30: 538–539

    PubMed  Google Scholar 

  46. West HH, Mani RL, Eisenberg RL, Tuerk K, Stacker TB (1977) Normal cerebral angiography in patients with spontaneous subarachnoid hemorrhage. Neurology 27: 592–594

    PubMed  Google Scholar 

  47. Winn HR, Richardson AE, Jane JA (1977) The long term prognosis in untreated cerebral aneurysms: 1. A 10 years evaluation of 364 patients. Ann Neurol 1: 358–370

    PubMed  Google Scholar 

  48. YaŞargil MG (1984) Pathological considerations. In: YaŞargil MG (ed) Microneurosurgery, vol 1. G Thieme, Stuttgart, pp 347–349

    Google Scholar 

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Authors and Affiliations

  1. Service of Neurosurgery, Hospital “12 Octubre” and Facultad de Medicina Universidad Complutense, Madrid, Spain

    P. A. Gómez, R. D. Lobato, J. J. Rivas, A. Cabrera, R. Sarabia, S. Castro, M. Castañeda & J. M. Cañizal

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  1. P. A. Gómez
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  2. R. D. Lobato
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  3. J. J. Rivas
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  4. A. Cabrera
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  5. R. Sarabia
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  6. S. Castro
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  7. M. Castañeda
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  8. J. M. Cañizal
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Gómez, P.A., Lobato, R.D., Rivas, J.J. et al. Subarachnoid haemorrhage of unknown aetiology. Acta neurochir 101, 35–41 (1989). https://doi.org/10.1007/BF01410066

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