Yield of Cather Angiography After Computed Tomography Negative, Lumbar Puncture Positive Subarachnoid Hemorrhage

Adam N WALLACE; Jeffrey N DINES; Gregory J ZIPFEL; Colin P DERDEYN

doi:10.1161/STROKEAHA.113.001234

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Yield of Cather Angiography After Computed Tomography Negative, Lumbar Puncture Positive Subarachnoid Hemorrhage

Journal article

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Peer reviewed

Yield of Cather Angiography After Computed Tomography Negative, Lumbar Puncture Positive Subarachnoid Hemorrhage

Adam N WALLACE, Jeffrey N DINES, Gregory J ZIPFEL and Colin P DERDEYN

Stroke (1970), Vol.44(6), pp.1729-1731

2013

DOI: 10.1161/STROKEAHA.113.001234

PMID: 23619131

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Abstract

Background and Purpose— Patients suspected of having aneurysmal subarachnoid hemorrhage (SAH) are initially evaluated with noncontrast head computed tomography. If the computed tomography is negative, but clinical concern for SAH is high, a lumbar puncture with cerebrospinal fluid analysis is typically performed. The purpose of this study was to evaluate the accuracy of cerebrospinal fluid xanthochromia and erythrocytosis for aneurysmal SAH. Methods— Medical records of all patients who underwent catheter angiography at Barnes Jewish Hospital between July 2002 and April 2012 for clinical suspicion of a ruptured brain aneurysm after a negative computed tomography scan and a lumbar puncture suspicious for SAH were reviewed. The cerebrospinal fluid analysis results, angiographic findings, and outcomes of each case were recorded. Results— Fifty-seven patients were identified. Two angiographic lesions were identified in patients with xanthochromia (2/24 patients, ie, 8.3%), both of which were confirmed to have ruptured. The diagnostic yield in patients with nonclearing erythrocytosis and no xanthochromia was 6.3% (1/16 patients), although this lesion was not considered the source of SAH. Conclusions— Catheter angiography should be performed in patients with computed tomography negative but suspicious lumbar puncture, particularly in the presence of xanthochromia. The benefit of angiography in patients with erythrocytosis only is unclear and deserves future study.

Neurology

Nervous System

Radiodiagnosis. Nmr imagery. Nmr spectrometry

Investigative techniques, diagnostic techniques (general aspects)

Biological and medical sciences

Vascular diseases and vascular malformations of the nervous system

Medical sciences

Details

Title: Subtitle: Yield of Cather Angiography After Computed Tomography Negative, Lumbar Puncture Positive Subarachnoid Hemorrhage
Creators: Adam N WALLACE - Mallinckrodt Institute of Radiology, St Louis, MO, United States
Jeffrey N DINES - Department of Neurology, Washington University School of Medicine, St Louis, MO, United States
Gregory J ZIPFEL - Department of Neurological Surgery and Neurology, Washington University School of Medicine, St Louis, MO, United States
Colin P DERDEYN - Department of Neurological Surgery and Neurology, Washington University School of Medicine, St Louis, MO, United States
Resource Type: Journal article
Publication Details: Stroke (1970), Vol.44(6), pp.1729-1731
Publisher: Lippincott Williams & Wilkins; Hagerstown, MD
DOI: 10.1161/STROKEAHA.113.001234
PMID: 23619131
ISSN: 0039-2499
eISSN: 1524-4628
Language: English
Date published: 2013
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984020767902771

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