Acta Neurochirurgica

, Volume 160, Issue 6, pp 1105–1113 | Cite as

Initial misdiagnosis of aneurysmal subarachnoid hemorrhage: associating factors and its prognosis

  • Se-yang Oh
  • Yong Cheol Lim
  • Yu Shik Shim
  • Jihye Song
  • Sang Kyu Park
  • Sook Young Sim
  • Myeong Jin Kim
  • Yong Sam Shin
  • Joonho ChungEmail author
Original Article - Vascular Neurosurgery - Aneurysm



Predicting the fate of patients who are given a misdiagnosis of aneurysmal subarachnoid hemorrhage (aSAH) remains unclear. The purpose was to examine factors associated with initial misdiagnosis of aSAH and to investigate the impact of initial misdiagnosis of aSAH on clinical outcomes.


Between January 2007 and December 2015, medical records and radiographic data for 3118 consecutive patients with aSAH were reviewed. There were 33 patients who had been documented with an initial misdiagnosis of aSAH, and all met the following criteria: (1) failure to correctly identify aSAH upon initial presentation to health care professionals; and 2) subsequently documented aSAH after the initial misdiagnosis. After applying exclusion criteria, remaining 2898 patients were included in the control group.


The most common cause of the misdiagnosis is failure to detect aSAH on the initial radiographic imaging. Misdiagnosis group showed lower initial Glasgow Coma Scale, better Hunt-Hess grade, and lower Fisher’s grade. Logistic regression analysis showed that initial HH grade (OR, 0.216; p = 0.014), initial Fisher’s grade (OR, 0.732; p = 0.036), and hospital type during initial contact (OR, 2.266; p = 0.042) were independently associated with misdiagnosis of aSAH.


Patients with initially good HH grade, lower Fisher’s grade, and visiting non-teaching hospital for initial contact were at risk of being misdiagnosed. Misdiagnosis of aSAH in patients with initial good HH grade did affect clinical outcomes negatively. The rebleeding rate was not significantly different between two groups. However, the mortality rate due to rebleeding was higher in MisDx group than in non-MisDx group.


Diagnosis Intracranial aneurysm Subarachnoid hemorrhage 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of retrospective study formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryInha University College of MedicineIncheonRepublic of Korea
  2. 2.Department of NeurosurgeryAjou University College of MedicineSuwonRepublic of Korea
  3. 3.Department of Neurosurgery, Konyang College of MedicineKonyang University HospitalDaejeonRepublic of Korea
  4. 4.Department of Neurosurgery, Incheon St. Mary’s HospitalThe Catholic University of KoreaIncheonRepublic of Korea
  5. 5.Department of NeurosurgeryInje University Seoul Paik HospitalSeoulRepublic of Korea
  6. 6.Department of NeurosurgeryGachon University Gil Medical CenterIncheonRepublic of Korea
  7. 7.Department of Neurosurgery, Seoul St. Mary’s HospitalThe Catholic University of KoreaSeoulRepublic of Korea
  8. 8.Department of NeurosurgerySeverance HospitalSeoulRepublic of Korea
  9. 9.Severance Institute for Vascular and Metabolic ResearchYonsei University College of MedicineSeoulRepublic of Korea

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