Author(s): Mohan M.; Rominiyi O.; Rasul F.; Souza R.D.; Jamjoom A.; Woodfield J.; Kolias A.; Patel K.; Kirollos R.; Chari A.
Source: British Journal of Neurosurgery; 2018; vol. 32 (no. 1); p. 98
Publication Date: 2018
Publication Type(s): Conference Abstract
Abstract:Objectives: Determine the incidence of positive delayed angiog-raphy, clinical outcomes and complications in patients with sub-arachnoid haemorrhage (SAH) and negative initial neurovascular imaging. Design: Systematic review of the literature. Outcome measures include delayed diagnoses of vascular anomalies and clinical outcomes. Subjects: 61 studies, including 4632 patients. Results: Patients were classified, into perimesencephalic SAH (pSAH, 44.9%), non-perimesencephalic SAH (non-pSAH, 49.7%) and SAH diagnosed by LP (LP+, 5.42%). A negative DSA was the most common initial neurovascular imaging strategy (62.3%), following by negative DSA and CTA (24.6%); only 1.6% of studies included patients with a negative CTA alone. The overall delayed pick-up rate was 4.6% (range 0-12.6%, 19 studies). Modified Rankin Scale scores of 0-2 were observed in 94.7% of pSAH, 86.5% of non-pSAH and 100% of LP+patients at 3-6 months. Pooled complication rates for re-bleeding (3.25%), seizures (3.17%), vasospasm (11.7%) and hydrocephalus (13.0%) were lowest in the LP+group and highest in the non-pSAH group. Conclusions: The heterogeneous investigation strategies, management and outcomes highlights the uncertainty in this field. Specific uncertainties for the practicing clinician include the need for immediate and delayed DSA in the era of modern CTA, the need for transfer to a neurosurgical centre for management, the need for neurovascular follow-up and how to counsel this diverse group of SAH patients with negative initial neurovascular imaging.