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Perimesencephalic subarachnoid hemorrhage: when to stop imaging?

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Abstract

To evaluate the yield of digital subtraction angiography (DSA) and repeated follow-up imaging in patients with initial pattern of perimesencephalic subarachnoid hemorrhage (PSAH) and negative computed tomography angiography (CTA) in excluding an underlying aneurysm. We conducted a retrospective analysis of all nontraumatic SAH who underwent a DSA between January 2006 and January 2010 and selected those with a PSAH pattern on CT done within 72 h from ictus. All CTAs were performed with a 64-section multidetector row CT scanner, and findings were compared with DSA and to follow-up imaging. Forty-nine patients with initial PSAH pattern and negative CTA who underwent subsequent DSA were identified. Six patients were excluded because CTA was not available in hospitals or 72 h after ictus. Only one patient (2.4%) had a false negative CTA with a 1-mm left ICA aneurysm seen on DSA, considered not to be the source of hemorrhage. An average of 2.0 ± 1.2 follow-up exams per patient (range 0–5) revealed no source of bleeding. One patient had a procedure-related transient complication, but evolved with no sequels. In patients with PSAH, CTA is reliable for ruling out an underlying aneurysm. DSA and, especially, further follow-up imaging have no increased diagnostic yield compared to initial negative CTA.

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Authors and Affiliations

  1. Department of Medical Imaging, University of Toronto, 150 College Street, Room 112, Toronto, ON, M5S 3E2, Canada

    Juan Pablo Cruz

  2. Department of Medical Imaging, University of Toronto–Saint Michael’s Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada

    Dipanka Sarma & Lyne Noel de Tilly

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  1. Juan Pablo Cruz
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  2. Dipanka Sarma
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  3. Lyne Noel de Tilly
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Correspondence to Lyne Noel de Tilly.

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Cruz, J.P., Sarma, D. & Noel de Tilly, L. Perimesencephalic subarachnoid hemorrhage: when to stop imaging?. Emerg Radiol 18, 197–202 (2011). https://doi.org/10.1007/s10140-011-0939-6

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  • DOI: https://doi.org/10.1007/s10140-011-0939-6

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