Article Text

other Versions

PDF
Research paper
Appreciation of CT-negative, lumbar puncture-positive subarachnoid haemorrhage: risk factors for presence of aneurysms and diagnostic yield of imaging
  1. Nicolaas A Bakker1,
  2. Rob J M Groen1,
  3. Mahrouz Foumani1,
  4. Maarten Uyttenboogaart2,
  5. Omid S Eshghi3,
  6. Jan D M Metzemaekers1,
  7. Gert Jan Luijckx2,
  8. J Marc C Van Dijk1
  1. 1Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  2. 2Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  3. 3Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  1. Correspondence to Dr Nicolaas A Bakker, Department of Neurosurgery AB71, University Medical Center Groningen, P.O. Box 30.001, Groningen 9700 RB, The Netherlands; n.a.bakker{at}umcg.nl

Abstract

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.

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.