Appreciation of CT-negative, lumbar puncture-positive subarachnoid haemorrhage: risk factors for presence of aneurysms and diagnostic yield of imaging
| Autor: | Gert-Jan Luijckx, Jan D M Metzemaekers, Mahrouz Foumani, Nicolaas A. Bakker, Omid S. Eshghi, Maarten Uyttenboogaart, Rob J. M. Groen, J. Marc C. van Dijk |
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| Jazyk: | angličtina |
| Rok vydání: | 2014 |
| Předmět: |
Adult
Male medicine.medical_specialty Neuroimaging Spinal Puncture Neurosurgical Procedures Cohort Studies Diagnosis Differential Young Adult Aneurysm Risk Factors medicine Humans COMPUTED-TOMOGRAPHY cardiovascular diseases METAANALYSIS Aged medicine.diagnostic_test Arterial dissection business.industry Lumbar puncture CEREBRAL-ANGIOGRAPHY Angiography Digital Subtraction Digital subtraction angiography Middle Aged Subarachnoid Hemorrhage medicine.disease Surgery Cerebral Angiography Psychiatry and Mental health Treatment Outcome Angiography Cohort Female Neurology (clinical) Radiology Abnormality business Tomography X-Ray Computed SCAN Cerebral angiography Follow-Up Studies |
| Zdroj: | Journal of Neurology, Neurosurgery and Psychiatry, 85(8), 883-886. BMJ PUBLISHING GROUP |
| ISSN: | 1468-330X |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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