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.
Similar content being viewed by others
References
Alexander MSM, Dias PS, Uttley D (1986) Spontaneous subarachnoid haemorrhage and negative cerebral panangiography. J Neurosurg 64: 537–542
Andrioli GC, Salar G, Rigobello L, Mingrino S (1979) Subarachnoid haemorrhage of unknown etiology. Acta Neurochir (Wien) 48: 217–221
Beguelin C, Seiler R (1983) Subarachnoid haemorrhage with normal cerebral panangiography. Neurosurgery 13: 409–411
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
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
Bonita R, Thompson S (1985) Subarachnoid haemorrhage: epidemiology, diagnosis, management and outcome. Stroke 4: 591–594
Brismar J, Sundbärg G (1985) Subarachnoid haemorrhage of unknown origin: Prognosis and prognostic factors. J Neurosurg 63: 349–354
Cioffi F, Pasqualin A, Cavazzani P, DaPian R (1989) Subarachnoid haemorrhage of unknown origin: clinical and tomographical aspects. Acta Neurochir (Wien) 97: 31–39
Eskesen V, Sorensen E, Rosenorn J, Schmidt K (1984) The prognosis in subarachnoid haemorrhage of unknown etiology. J Neurosurg 61: 1029–1031
Fisher CM, Kitler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid haemorrhage visualized by computerized tomographie scanning. J Neurosurg 6: 1–9
Fogelholm R (1981) Subarachnoid haemorrhage in Middle-Finland: incidence, early prognosis and indications for neurosurgical treatment. Stroke 12: 296–301
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
Gilbert J, Lee C, Young B (1990) Repeat cerebral pan-angiography in subarachnoid haemorrhage of unknown etiology. Surg Neurol 33: 19–21
Giombini S, Bruzzone M, Pluchino F (1988) Subarachnoid haemorrhage of unexplaned cause. Neurosurgery 2: 313–316
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
Hayward R (1977) Subarachnoid haemorrhage of unknown aetiology. A clinical and radiological study of 51 cases. J Neurol Neurosurg Psychiatry 40: 926–931
Hunt WE, Hess RM (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28: 14–20
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
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
Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. A practical scale. Lancet 1: 480–484
Juul R, Fredriksen T, Ringkjob R (1986) Prognosis in subarachnoid haemorrhage of unknown etiology. J Neurosurg 64: 359–362
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
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
Levy L (1960) Subarachnoid haemorrhage without arteriographic vascular abnormality. J Neurosurg 17: 252–258
Lorenzo N, Guidetti G (1988) Anterior communicating aneurysms missed at angiography: report of two cases treated surgically. Neurosurgery 4: 494–499
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
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
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
Pakarinen S (1967) Incidence, aetiology, and prognosis of primary subarachnoid haemorrhage. Acta Neurol Scand 43 [Suppl 29]: 1–128
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
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
Shepard R (1984) Prognosis of spontaneous (non-traumatic) subarachnoid haemorrhage of unknown cause. Lancet 7: 777–778
Sonesson B, Säveland H, Ljunggren B, Brandt L (1989) Cognitive functioning after subarachnoid haemorrhage of unknown origin. Acta Neurol Scand 80: 400–410
Spallone A, Ferrante L, Palatisky E, Santoro A, Acqui M (1986) Subarachnoid haemorrhage of unknown origin. Acta Neurochir (Wien) 80: 12–17
Standnes B, Heilo A (1980) Subarachnoid haemorrhage of unknown etiology. J Oslo City Hosp 30: 151–152
Sundbärg G, Brismar J, Ljunggren B (1982) SAH of unknown origin. A good-natured catastrophe. Acta Neurochir (Wien) 66: 251
Suzuki S, Kayama T, Sakurai Y, Ogawa A, Suzuki J (1987) Subarachnoid haemorrhage of unknown cause. Neurosurgery 21: 310–313
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
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
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
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
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
West H, Mani R, Eisenberg R, Tuerk K, Stucker T (1977) Normal cerebral arteriography in patients with spontaneous subarachnoid haemorrhage. Neurology 27: 592–594
Wijdicks E, Kerkhoff H, van Gijn J (1988) Long-term followup of 71 patients with thunderclap headache mimicking subarachnoid haemorrhage. Lancet 9: 68–70
Yoshida M, Anegawa S, Moritaka K (1981) Significance of infundibular dilatation in unexplained subarachnoid haemorrhage. Neurosurgery 6: 718–721
Author information
Authors and Affiliations
Rights 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
Issue Date:
DOI: https://doi.org/10.1007/BF01541778