ArticleAJNR. American journal of neuroradiology2022
Angiographically Occult Subarachnoid Hemorrhage: Yield of Repeat Angiography, Influence of Initial CT Bleed Pattern, and Sources of Diagnostic Error in 242 Consecutive Patients.
Article in AJNR. American journal of neuroradiology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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9 citing papers in PubMed, 15 citations in OpenAlex.
- Clinical and epidemiological comparison between perimesencephalic and non-perimesencephalic, non-aneurysmal subarachnoid hemorrhage: a single-center cohort study from a referral center in a developing country.Arquivos de neuro-psiquiatria · 2026Article
- Delayed identification and treatment of a cervicomedullary spinal vascular lesion following angiogram-negative, high-grade subarachnoid hemorrhage: illustrative case.Journal of neurosurgery. Case lessons · 2026Article
- Swedish nationwide study of 377 patents with non-aneurysmal subarachnoid haemorrhage: a disease with distinct demographics and risk factors.Journal of neurology, neurosurgery, and psychiatry · 2026Article
- Perimesencephalic non-aneurysmal subarachnoid hemorrhage: is there a need for repeat digital subtraction angiography?Neuroradiology · 2025Article
- Development of a deep-learning algorithm for etiological classification of subarachnoid hemorrhage using non-contrast CT scans.European radiology · 2025Article
- A Case of Coil Embolization for an Angiographically Occult Ruptured Anterior Communicating Artery Aneurysm.Journal of neuroendovascular therapy · 2025Article
- Appearance of an anterior communicating artery aneurysm during vasospasm treatment after angiogram-negative subarachnoid hemorrhage: A case report.Surgical neurology international · 2025Article
- Vessel Wall Imaging in Angiogram-Negative Diffuse Subarachnoid Hemorrhage Reveals a Ruptured Lenticulostriate Aneurysm.Neurointervention · 2024Article
- Current status of perimesencephalic non-aneurysmal subarachnoid hemorrhage.Frontiers in neurology · 2022Review
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Authors and funding
7 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
background and purposeNearly 20% of patients with spontaneous SAH have no definitive source on initial DSA. The purpose of this study was to investigate the timing and yield of repeat DSA, to clarify the influence of initial CT bleed pattern, and to characterize sources of diagnostic error in this scenario. MATERIALS AND
methodsWe evaluated the yield of repeat DSA and clinical outcomes stratified by hemorrhage pattern on CT in consecutive patients with nontraumatic SAH with negative initial DSA findings at a referral center. Cases in which the culprit lesion was subsequently diagnosed were classified as physiologically occult (ie, undetectable) on the initial DSA, despite adequate technique and interpretation or misdiagnosed due to operator-dependent error.
resultsTwo hundred forty-two of 1163 (20.8%) patients with spontaneous SAH had negative initial DSA findings between 2009 and 2018. The SAH CT pattern was nonperimesencephalic (41%), perimesencephalic (36%), sulcal (18%), and CT-negative (5%). Repeat DSA in 135/242 patients (55.8%) revealed a source in 10 patients (7.4%): 4 saccular aneurysms, 4 atypical aneurysms, and 2 arteriovenous shunts. The overall yield of repeat DSA was 11.3% with nonperimesencephalic and 2.2% for perimesencephalic patterns. The yield of the second and third DSAs with a nonperimesencephalic pattern was 7.7% and 12%, respectively. Physiologically occult lesions accounted for 6/242 (2.5%) and operator-dependent errors accounted for 7/242 (2.9%) of all angiographically occult lesions on the first DSA.
conclusionsAtypical aneurysms and small arteriovenous shunts are important causes of SAH negative on angiography. Improving DSAs technique can modestly reduce the need for repeat DSA; however, a small fraction of SAH sources remain occult despite adequate technique. These findings support the practice of repeating DSA in patients with a nonperimesencephalic SAH pattern.
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