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Open Access 01-10-2019 | Subarachnoid Hemorrhage | Review Article - Vascular Neurosurgery - Other

Subarachnoid haemorrhage with negative initial neurovascular imaging: a systematic review and meta-analysis

Authors: Midhun Mohan, Abdurrahman I. Islim, Fahid T. Rasul, Ola Rominiyi, Ruth-Mary deSouza, Michael T. C. Poon, Aimun A. B. Jamjoom, Angelos G. Kolias, Julie Woodfield, Krunal Patel, Aswin Chari, Ramez Kirollos, British Neurosurgical Trainee Research Collaborative

Published in: Acta Neurochirurgica | Issue 10/2019

Abstract

Background

In patients with spontaneous subarachnoid haemorrhage (SAH), a vascular cause for the bleed is not always found on initial investigations. This study aimed to systematically evaluate the delayed investigation strategies and clinical outcomes in these cases, often described as “non-aneurysmal” SAH (naSAH).

Methods

A systematic review was performed in concordance with the PRISMA checklist. Pooled proportions of primary outcome measures were estimated using a random-effects model.

Results

Fifty-eight studies were included (4473 patients). The cohort was split into perimesencephalic naSAH (PnaSAH) (49.9%), non-PnaSAH (44.7%) and radiologically negative SAH identified on lumbar puncture (5.4%). The commonest initial vascular imaging modality was digital subtraction angiography. A vascular abnormality was identified during delayed investigation in 3.9% [95% CI 1.9–6.6]. There was no uniform strategy for the timing or modality of delayed investigations. The pooled proportion of a favourable modified Rankin scale outcome (0–2) at 3–6 months following diagnosis was 92.0% [95% CI 86.0–96.5]. Complications included re-bleeding (3.1% [95% CI 1.5–5.2]), hydrocephalus (16.0% [95% CI 11.2–21.4]), vasospasm (9.6% [95% CI 6.5–13.3]) and seizure (3.5% [95% CI 1.7–5.8]). Stratified by bleeding pattern, we demonstrate a higher rate of delayed diagnoses (13.6% [95% CI 7.4–21.3]), lower proportion of favourable functional outcome (87.2% [95% CI 80.1–92.9]) and higher risk of complications for non-PnaSAH patients.

Conclusion

This study highlights the heterogeneity in delayed investigations and outcomes for patients with naSAH, which may be influenced by the initial pattern of bleeding. Further multi-centre prospective studies are required to clarify optimal tailored management strategies for this heterogeneous group of patients.

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Title: Subarachnoid haemorrhage with negative initial neurovascular imaging: a systematic review and meta-analysis
Authors: Midhun Mohan
Abdurrahman I. Islim
Fahid T. Rasul
Ola Rominiyi
Ruth-Mary deSouza
Michael T. C. Poon
Aimun A. B. Jamjoom
Angelos G. Kolias
Julie Woodfield
Krunal Patel
Aswin Chari
Ramez Kirollos
British Neurosurgical Trainee Research Collaborative
Publication date: 01-10-2019
Publisher: Springer Vienna
Keywords: Subarachnoid Hemorrhage
Subarachnoid Hemorrhage
CT Angiography
Published in: Acta Neurochirurgica / Issue 10/2019
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-019-04025-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Subarachnoid haemorrhage with negative initial neurovascular imaging: a systematic review and meta-analysis

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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