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. 2023;13(1):91-96.
doi: 10.1159/000534529. Epub 2023 Oct 28.

Frequency and Characteristics of Spinal Bleeding Sources in Nontraumatic Angiogram-Negative Subarachnoid Hemorrhage

Tim Lampmann  1 , Simon Brandecker  1 , Johannes Weller  2 , Frederic Carsten Schmeel  3 , Harun Asoglu  1 , Motaz Hamed  1 , Alexander Radbruch  3 , Erdem Güresir  1 , Hartmut Vatter  1 , Mohammed Banat  1
Affiliations

Frequency and Characteristics of Spinal Bleeding Sources in Nontraumatic Angiogram-Negative Subarachnoid Hemorrhage

Tim Lampmann et al. Cerebrovasc Dis Extra. 2023.

Abstract

Introduction: Angiogram-negative subarachnoid hemorrhage (AN-SAH) accounts for 5-15% of spontaneous SAH. This study aims to analyze the frequency and characteristics of spinal bleeding sources in patients with AN-SAH.

Methods: 140 patients suffering from AN-SAH treated at our institution from 2012 to 2022 were included in this retrospective cohort study.

Results: 52.1% were diagnosed with perimesencephalic SAH, 35.0% with non-perimesencephalic, SAH and 12.9% with CT-negative SAH (diagnosed by lumbar puncture). Additional magnetic resonance imaging (MRI) identified a spinal bleeding source in 4 patients (2.86%). These patients presented with local spine pain or neurological deficits (relative risk: 3.9706 [95% confidence interval [CI]: 0.7272-21.6792]; p < 0.001) and were younger (mean difference 14.85 years [95% CI: 0.85-28.85; p = 0.038]) compared to patients without a spinal bleeding source.

Conclusions: AN-SAH caused by spinal pathology is rare. This study indicates that craniocervical and holospinal MRI should be considered in AN-SAH, especially for young patients with AN-SAH who present with back pain or neurological deficits.

Keywords: Digital subtraction angiography; Non-aneurysmal subarachnoid hemorrhage; Spinal bleeding source; Spontaneous subarachnoid hemorrhage.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1.
Fig. 1.
Exemplary MRI-images of spinal bleeding sources. Red circles indicating the pathologies. a Intraspinal aneurysm at T3. b MRI of an arteriovenous malformation at C3/4.
See this image and copyright information in PMC

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