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Reangiographie nach perimesenzephaler Subarachnoidalblutung

Reangiography after perimesencephalic subarachnoid hemorrhage

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Zusammenfassung

Hintergrund

Die Studie dient zur Evaluation der Wertigkeit der repetitiven digitalen Subtraktionsangiographie (DSA) zur Detektion von Blutungsquellen bei spontanen präpontinen und perimesenzephalen Subarachnoidalblutungen (SAB) nach initial negativer invasiver und nichtinvasiver Bildgebung (computertomographische Angiographie [CTA], DSA und magnetresonanztomographische Angiographie [MRA]).

Material und Methoden

Wir analysierten über einen Zeitraum von 10 Jahren (2002 bis 2011) 750 Patienten mit einer akuten atraumatischen SAB, von denen 30 eine rein perimesenzephale SAB aufwiesen und gleichzeitig in der ersten DSA, CTA und MRA keine Blutungsquelle nachgewiesen werden konnte.

Ergebnisse

Bei einem Patienten (3,3 %) konnte in einer Reangiographie ein Aneurysma nachgewiesen werden. Bei allen anderen Patienten ließ sich auch im Verlauf keine Blutungsquelle zeigen.

Schlussfolgerung

In Einzelfällen zeigt sich erst in einer Reangiographie eine Blutungsquelle. Diese seltenen Befunde haben aber eine therapeutische und prognostische Relevanz, insbesondere da es sich um Aneurysmen im hinteren Kreislauf handeln kann, mit entsprechend höherer Rupturwahrscheinlichkeit. Wir empfehlen daher eine Reangiographie nach initial negativer Bildgebung auch bei Patienten mit prognostisch günstiger, isoliert perimesenzephaler SAB und unter Berücksichtigung des Komplikationsrisikos einer zerebralen DSA.

Summary

Background

This study aimed to determine the value of digital subtraction angiography (DSA) for the detection of causative vascular lesions in patients with perimesencephalic subarachnoid hemorrhage (SAH) after initially negative noninvasive and invasive neurovascular imaging, such as computed tomography angiography (CTA), DSA and magnetic resonance angiography (MRA).

Materials and methods

We analyzed the value of repeated DSA for the detection of causative vascular lesions in 750 patients presenting to our institution with SAH and including 30 with a purely perimesencephalic pattern of subarachnoidal hemorrhage and initially negative noninvasive and invasive neurovascular imaging over a 10-year period.

Results

Repeated DSA demonstrated a causative vascular lesion in 1 patient (3.3 %) but no causative vascular lesions were detected in the other patients.

Conclusions

Repeated DSA can be used to detect a source of hemorrhage after initially negative imaging diagnostics in some rare cases. Such a finding has a therapeutic and prognostic impact especially for aneurysms in the posterior circulation which bear a higher risk of renewed hemorrhaging. Therefore, we believe that repeated DSA should be recommended in patients with perimesencephalic SAH even under consideration of the risk of complications caused by a second invasive DSA.

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Authors and Affiliations

  1. Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland

    A. Ringelstein, O. Timochenko, C. Moenninghoff, M. Forsting & M. Schlamann

  2. Klinik für Neurochirurgie, Universitätsklinikum Essen, Essen, Deutschland

    O. Mueller & U. Sure

Authors
  1. A. Ringelstein
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  2. O. Mueller
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  3. O. Timochenko
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  4. C. Moenninghoff
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  5. U. Sure
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  6. M. Forsting
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  7. M. Schlamann
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Correspondence to A. Ringelstein.

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Ringelstein, A., Mueller, O., Timochenko, O. et al. Reangiographie nach perimesenzephaler Subarachnoidalblutung. Nervenarzt 84, 715–719 (2013). https://doi.org/10.1007/s00115-013-3803-y

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  • DOI: https://doi.org/10.1007/s00115-013-3803-y

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