[Spontaneous subarachnoid hemorrhage: patients' examination after aneurysm-negative initial angiograms].

AIM OF THE STUDY: To find out, which patients in case of subarachnoid hemorrhage and negative initial angiograms need a repeated investigation, when it should be repeated and what kind of angiographic investigation should be performed. MATERIALS AND METHODS: Fifty seventh patients with subarachnoid hemorrhage and negative initial angiograms were investigated in Department of Neurosurgery of Kaunas University of Medicine Hospital from January 2001 to August 2002. They underwent a repeated angiography (digital subtraction or computed tomography angiography) generally in the period of 10 days. RESULTS: Repeated cerebral angiography revealed saccular aneurysms of various locations in 23 patients. Perimesencephalic hemorrhage was present in 24 cases and no aneurysms were detected in these cases. Aneurysm was suspected in initial angiography in 14 cases and 10 of them were confirmed after second angiography. In all cases of application computed tomography angiography provided equal or more information for neurosurgeon compared to digital subtraction angiography. Nearly half of the detected aneurysms (n = 11) were small (< 5 mm). CONCLUSIONS: Repeated angiography is not recommended in case of perimesencephalic pattern of spontaneous subarachnoid hemorrhage. In case of suspicion of aneurysm in initial angiography, computed tomography angiography could be a method of choice performed immediately.