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Appreciation of CT-negative, lumbar puncture-positive subarachnoid haemorrhage: risk factors for presence of aneurysms and diagnostic yield of imaging

Bakker, N. A., Groen, R. J. M., Foumani, M., Uyttenboogaart, M., Eshghi, O. S., Metzemaekers, J., Luijckx, G. J. & van Dijk, J. M. C., Aug-2014, In : Journal of Neurology, Neurosurgery and Psychiatry. 85, 8, p. 883-886 4 p.

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  • J Neurol Neurosurg Psychiatry-2014-Bakker-885-8

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DOI

OBJECTIVE: Patients without a subarachnoid haemorrhage (SAH) on brain CT scan (CT-negative), but a lumbar puncture (LP)-proven SAH, are a challenging patient category. The optimal diagnostic approach is still a matter of debate. Also, there is little knowledge on the probability of finding an underlying vascular lesion.

DESIGN: In this observational study, a consecutive cohort of 94 patients with CT-negative, LP-positive SAH was prospectively collected between 1998 and 2013. The yield of diagnostic modalities as well as patient outcome was studied. In addition, risk factors for the presence of a vascular lesion were analysed.

RESULTS: In 40 patients (43%), an intracranial vascular abnormality was detected: 37 aneurysms and three arterial dissections. Female gender was significantly associated with detection of a vascular lesion. Time between ictus and diagnosis of SAH was not associated with the presence of vascular pathology. Overall, 99% of patients had a modified Rankin Score of 0-2 after a median follow-up of 72 months. The yield of additional digital subtraction angiography in patients with a negative CT angiography was zero.

CONCLUSIONS: In this study, the chance of finding a vascular lesion in a patient with CT-negative, LP-positive SAH was 43%, underlining the need for an adequate diagnostic workup. In general, the patient outcome was favourable. Female gender was found to be predictive for detecting a vascular lesion. In contrast with previous reports, the interval between ictus and LP was not associated with the presence of an aneurysm.

Original languageEnglish
Pages (from-to)883-886
Number of pages4
JournalJournal of Neurology, Neurosurgery and Psychiatry
Volume85
Issue number8
Publication statusPublished - Aug-2014

    Keywords

  • COMPUTED-TOMOGRAPHY, CEREBRAL-ANGIOGRAPHY, SCAN, METAANALYSIS

ID: 13587820