Skip to main content
SpringerLink
Log in

Subarachnoid haemorrhage of unknown aetiology

  • Clinical Articles
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Summary

Eighty-six of 996 patients with primary subarachnoid haemorrhage (SAH) had negative panangiography studies. These 86 patients with subarachnoid haemorrhage of unknown origin (SAH-NUD) were compared with 853 patients sustaining an aneurysmal bleed (SAH-A) admitted during the same period 1980–1989. The age and sex distribution of both groups were similar. The SAH-NUD group was in better condition on admission, with less blood evident on CT scan. All 16 (repeat control) angiography studies in the SAH-NUD group were negative. During a follow-up period ranging from 1 to 10 years (mean 5.4 years), two patients experienced rebleeding with negative repeat angiographies and subsequent total recovery. Using the Glasgow Outcome Scale (GOS) the final outcome was good in 86% of the study group and 54% of the aneurysm group. However, half of the SAH-NUD patients complained of persistent symptoms at long-term follow-up. Thus, despite a generally good prognosis, for a given individual SAH-NUD may be catastrophic with many residual symptoms persisting for the rest of the person's life.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Alexander MSM, Dias PS, Uttley D (1986) Spontaneous subarachnoid haemorrhage and negative cerebral panangiography. J Neurosurg 64: 537–542

    Google Scholar 

  2. Andrioli GC, Salar G, Rigobello L, Mingrino S (1979) Subarachnoid haemorrhage of unknown etiology. Acta Neurochir (Wien) 48: 217–221

    Google Scholar 

  3. Beguelin C, Seiler R (1983) Subarachnoid haemorrhage with normal cerebral panangiography. Neurosurgery 13: 409–411

    Google Scholar 

  4. Björkesten af G, Halonen V (1965) Incidence of intra-cranial vascular lesion in patients with subarachnoid haemorrhage investigated by four-vessel angiography. J Neurosurg 1: 29–32

    Google Scholar 

  5. Björkesten af G, Troupp H (1957) Prognosis of subarachnoid haemorrhage a comparison between patients with verified aneurysms and patients with normal angiograms. J Neurosurg 14: 434–441

    Google Scholar 

  6. Bonita R, Thompson S (1985) Subarachnoid haemorrhage: epidemiology, diagnosis, management and outcome. Stroke 4: 591–594

    Google Scholar 

  7. Brismar J, Sundbärg G (1985) Subarachnoid haemorrhage of unknown origin: Prognosis and prognostic factors. J Neurosurg 63: 349–354

    Google Scholar 

  8. Cioffi F, Pasqualin A, Cavazzani P, DaPian R (1989) Subarachnoid haemorrhage of unknown origin: clinical and tomographical aspects. Acta Neurochir (Wien) 97: 31–39

    Google Scholar 

  9. Eskesen V, Sorensen E, Rosenorn J, Schmidt K (1984) The prognosis in subarachnoid haemorrhage of unknown etiology. J Neurosurg 61: 1029–1031

    Google Scholar 

  10. Fisher CM, Kitler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid haemorrhage visualized by computerized tomographie scanning. J Neurosurg 6: 1–9

    Google Scholar 

  11. Fogelholm R (1981) Subarachnoid haemorrhage in Middle-Finland: incidence, early prognosis and indications for neurosurgical treatment. Stroke 12: 296–301

    Google Scholar 

  12. Forster D, Steiner L, Hakanson S, Bergvall U (1978) The value of repeat pan-angiography in cases of unex plained subarachnoid haemorrhage. J Neurosurg 48: 712–716

    Google Scholar 

  13. Gilbert J, Lee C, Young B (1990) Repeat cerebral pan-angiography in subarachnoid haemorrhage of unknown etiology. Surg Neurol 33: 19–21

    Google Scholar 

  14. Giombini S, Bruzzone M, Pluchino F (1988) Subarachnoid haemorrhage of unexplaned cause. Neurosurgery 2: 313–316

    Google Scholar 

  15. Gomez P, Lobato R, Rivas J, Cabrera A, Sarabia R, Castro S, Castaneda M, Canizal J (1989) Subarachnoid haemorrhage of unknown etiology. Acta Neurochir (Wien) 101: 35–41

    Google Scholar 

  16. Hayward R (1977) Subarachnoid haemorrhage of unknown aetiology. A clinical and radiological study of 51 cases. J Neurol Neurosurg Psychiatry 40: 926–931

    Google Scholar 

  17. Hunt WE, Hess RM (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28: 14–20

    Google Scholar 

  18. Iwanaga H, Wakai S, Ochiai C, Narita J, Inoh S, Nagai M (1990) Ruptured cerebral aneurysms missed by initial angiographic study. Neurosurgery 27: 45–51

    Google Scholar 

  19. Jain V, Hedge T, Easwaran R Das B, Reddy G (1987) Benign subarachnoid haemorrhage. Subarachnoid haemorrhage of unknown aetiology. Acta Neurochir (Wien) 86: 89–92

    Google Scholar 

  20. Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. A practical scale. Lancet 1: 480–484

    Google Scholar 

  21. Juul R, Fredriksen T, Ringkjob R (1986) Prognosis in subarachnoid haemorrhage of unknown etiology. J Neurosurg 64: 359–362

    Google Scholar 

  22. Juvela S, Kaste M, Hillbom M (1989) The effects of earlier surgery and shorter bedrest on the outcome in patients with subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 52: 776–777

    Google Scholar 

  23. Kawamura S, Yasui N (1990) Clinical and long-term follow-up study in patients with spontaneous subarachnoid haemorrhage of unknown aetiology. Acta Neurochir (Wien) 106: 110–114

    Google Scholar 

  24. Levy L (1960) Subarachnoid haemorrhage without arteriographic vascular abnormality. J Neurosurg 17: 252–258

    Google Scholar 

  25. Lorenzo N, Guidetti G (1988) Anterior communicating aneurysms missed at angiography: report of two cases treated surgically. Neurosurgery 4: 494–499

    Google Scholar 

  26. Mohsen F, Pomonis S, Illingworth R (1984) Prediction of delayed cerebral ischaemia after subarachnoid haemorrhage by computed tomography. J Neurol Neurosurg Psychiatry 47: 1197–1202

    Google Scholar 

  27. Nishioka H, Torner J, Graf C, Kassell N, Sash A, Goettler L (1984) Cooperative study on intracranial aneurysms and subarachnoid haemorrhage: a long-term prognostic study II. Ruptured intracranial aneurysms managed conservativley. Arch Neurol 41: 1142–1146

    Google Scholar 

  28. Oder W, Kollegger H, Zeiler K, Dal-Bianco P, Wessely P, Deecke L (1991) Subarachnoid haemorrhage of unknown etiology: early prognostic factors for long-term functional capacity. J Neurosurg 74: 601–605

    Google Scholar 

  29. Pakarinen S (1967) Incidence, aetiology, and prognosis of primary subarachnoid haemorrhage. Acta Neurol Scand 43 [Suppl 29]: 1–128

    Google Scholar 

  30. Rinkel G, Wijdicks E, Vermeulen M, Hageman I, Tans J, van Gijn J (1990) Outcome in perimesencephalic (nonaneurysmal) subarachnoid haemorrhage: a follow-up study in 37 patients. Neurology 40: 1130–1132

    Google Scholar 

  31. Sarti C, Tuomilehto J, Narva E, Salmi K, Sivenius J, Kaarsalo E (1990) Epidemiology of subarachnoid haemorrhage in Finland during years 1982–85. First European Stroke Conference, Düsseldorf. J Neurology 237: 142

    Google Scholar 

  32. Shepard R (1984) Prognosis of spontaneous (non-traumatic) subarachnoid haemorrhage of unknown cause. Lancet 7: 777–778

    Google Scholar 

  33. Sonesson B, Säveland H, Ljunggren B, Brandt L (1989) Cognitive functioning after subarachnoid haemorrhage of unknown origin. Acta Neurol Scand 80: 400–410

    Google Scholar 

  34. Spallone A, Ferrante L, Palatisky E, Santoro A, Acqui M (1986) Subarachnoid haemorrhage of unknown origin. Acta Neurochir (Wien) 80: 12–17

    Google Scholar 

  35. Standnes B, Heilo A (1980) Subarachnoid haemorrhage of unknown etiology. J Oslo City Hosp 30: 151–152

    Google Scholar 

  36. Sundbärg G, Brismar J, Ljunggren B (1982) SAH of unknown origin. A good-natured catastrophe. Acta Neurochir (Wien) 66: 251

    Google Scholar 

  37. Suzuki S, Kayama T, Sakurai Y, Ogawa A, Suzuki J (1987) Subarachnoid haemorrhage of unknown cause. Neurosurgery 21: 310–313

    Google Scholar 

  38. Säveland H, Sonesson B, Ljunggren B, Brandt L, Uski T, Zyg-munt S, Hindfelt B (1986) Outcome evaluation following subarachnoid haemorrhage. J Neurosurg 64: 191–196

    Google Scholar 

  39. Tappura M (1962) Prognosis of subarachnoid haemorrhage: a study of 120 patients with unoperated vascular lesions demonstrable in bilateral carotid angiograms. Acta Med Scand [Suppl] 392: 1–75

    Google Scholar 

  40. van Gijn J, van Dongen K (1980) Computerized tomography in subarachnoid haemorrhage: difference between patients with and without an aneurysm on angiography. Neurology 30: 538–539

    Google Scholar 

  41. van Gijn J, van Dongen K, Vermeulen M, Hijdra A (1985) Perimesencephalic haemorrhage: a nonaneurysmal and benign from of subarachnoid haemorrhage. Neurology 35: 493–497

    Google Scholar 

  42. Vilkki J, Holst P, Öhman J, Servo A, Heiskanen O (1990) Social outcome related to cognitive performance and computed tomographic findings after surgery for a ruptured intracranial aneurysm. Neurosurgery 4: 579–585

    Google Scholar 

  43. West H, Mani R, Eisenberg R, Tuerk K, Stucker T (1977) Normal cerebral arteriography in patients with spontaneous subarachnoid haemorrhage. Neurology 27: 592–594

    Google Scholar 

  44. Wijdicks E, Kerkhoff H, van Gijn J (1988) Long-term followup of 71 patients with thunderclap headache mimicking subarachnoid haemorrhage. Lancet 9: 68–70

    Google Scholar 

  45. Yoshida M, Anegawa S, Moritaka K (1981) Significance of infundibular dilatation in unexplained subarachnoid haemorrhage. Neurosurgery 6: 718–721

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, University Hospital of Kuopio, Kuopio, Finland

    A. Ronkainen & J. Hernesniemi

Authors
  1. A. Ronkainen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Hernesniemi
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ronkainen, A., Hernesniemi, J. Subarachnoid haemorrhage of unknown aetiology. Acta neurochir 119, 29–34 (1992). https://doi.org/10.1007/BF01541778

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01541778

Keywords

Search

Navigation