Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jan;164(1):129-140.
doi: 10.1007/s00701-021-05069-7. Epub 2021 Dec 1.

Spontaneous angiogram-negative subarachnoid hemorrhage: a retrospective single center cohort study

Alexander Achrén  1 , Rahul Raj  2 , Jari Siironen  2 , Aki Laakso  2   3 , Johan Marjamaa  2
Affiliations

Spontaneous angiogram-negative subarachnoid hemorrhage: a retrospective single center cohort study

Alexander Achrén et al. Acta Neurochir (Wien). 2022 Jan.

Abstract

Background: Spontaneous angiogram-negative subarachnoid hemorrhage (SAH) is considered a benign illness with little of the aneurysmal SAH-related complications. We describe the clinical course, SAH-related complications, and outcome of patients with angiogram-negative SAH.

Methods: We retrospectively reviewed all adult patients admitted to a neurosurgical intensive care unit during 2004-2018 due to spontaneous angiogram-negative SAH. Our primary outcome was a dichotomized Glasgow Outcome Scale (GOS) at 3 months. We assessed factors that associated with outcome using multivariable logistic regression analysis.

Results: Of the 108 patients included, 84% had a favorable outcome (GOS 4-5), and mortality was 5% within 1 year. The median age was 58 years, 51% were female, and 93% had a low-grade SAH (World Federation of Neurosurgical Societies grading I-III). The median number of angiograms performed per patient was two. Thirty percent of patients showed radiological signs of acute hydrocephalus, 28% were acutely treated with an external ventricular drain, 13% received active vasospasm treatment and 17% received a permanent shunt. In the multivariable logistic regression model, only acute hydrocephalus associated with unfavorable outcome (odds ratio = 4.05, 95% confidence interval = 1.05-15.73). Two patients had a new bleeding episode.

Conclusion: SAH-related complications such as hydrocephalus and vasospasm are common after angiogram-negative SAH. Still, most patients had a favorable outcome. Only acute hydrocephalus was associated with unfavorable outcome. The high rate of SAH-related complications highlights the need for neurosurgical care in these patients.

Keywords: Intensive care unit; Perimesencephalic subarachnoid hemorrhage; Spontaneous subarachnoid hemorrhage; Subarachnoid hemorrhage.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1.
Fig. 1.
Flow chart showing study population
See this image and copyright information in PMC

References

    1. Alexander MSM, Dias PS, Uttley D. Spontaneous subarachnoid hemorrhage and negative cerebral panangiography: Review of 140 cases. J Neurosurg. 1986;64(4):537–542. doi: 10.3171/jns.1986.64.4.0537. - DOI - PubMed
    1. Allen GS, Ahn HS, Preziosi TJ, et al. Cerebral arterial spasm--a controlled trial of nimodipine in patients with subarachnoid hemorrhage. N Engl J Med. 1983;308(11):619–624. doi: 10.1056/NEJM198303173081103. - DOI - PubMed
    1. Boswell S, Thorell W, Gogela S, Lyden E, Surdell D. Angiogram-negative subarachnoid hemorrhage: outcomes data and review of the literature. J Stroke Cerebrovasc Dis. 2013;22(6):750–757. doi: 10.1016/j.jstrokecerebrovasdis.2012.02.001. - DOI - PubMed
    1. Burke T, Hughes S, Carr A, Javadpour M, Pender N. A systematic review of cognitive outcomes in angiographically negative subarachnoid haemorrhage. Neuropsychol Rev. 2018;28(4):453–469. doi: 10.1007/s11065-018-9389-1. - DOI - PubMed
    1. Dupont S, Rabinstein AA. Extent of acute hydrocephalus after subarachnoid hemorrhage as a risk factor for poor functional outcome. Neurol Res. 2013;35(2):107–110. doi: 10.1179/1743132812Y.0000000122. - DOI - PubMed

Publication types