Spontaneous subarachnoid hemorrhage and negative angiography: Clinical course and results of long-term follow-up

PURPOSE The aims of this study are to investigate the requirement of control imaging techniques which are used at follow up period of spontaneous subarachnoid hemorrhage with negative angiography and to evaluate the results of long term - natural history to make contribution to the literature. METHOD 84 patients admitted with a diagnosis of spontaneous subarachnoid hemorrhage and negative angiography between the years of 1998 and 2013 were included in the study. Clinical situation of the patients were graded by Hunt?Hess scale. CT scans were graded by using Fisher scale. The patients were classified to three groups as DSAH, PSAH and CT (-) SAH according to CT findings. The outcome of patients at discharge time and at the end of the long? term follow up period was measured by using GOS. RESULTS All of the control angiographies were negative. Hunt Hess scores of patients were smaller than 4. In the DSAH group clinical and radiological scores were recorded higher than the other groups. In the DSAH group 3 patients was died et follow up period. There were severe morbidity at two patients in the DSAH group. Out of this all of the patients were neurologically intact (GOS 5) at discharge and at the end of long-term follow up period. No rebleeding episode was recorded during hospitalization and follow up period. CONCLUSION The evaluation of patients with spontaneous subarachnoid hemorrhage and negative initial angiography is a diagnostic challenge. In company with literature according to results of our study, repeat angiography can be adviseable only for DSAH group. In the DSAH group complication rate is higher and the clinical results are worse than the other groups. This means that the pattern of the hemorrhage is the most important prognostic factor. In this subtype of hemorrhage comprehensive studies must be applied to find the underlying cause