NONTRAUMATIC SUBARACHNOID HEMORRHAGE - VALUE OF REPEAT ANGIOGRAPHY

PURPOSE: To evaluate the benefits and risks of repeat cerebral angiogr aphy in patients with subarachnoid hemorrhage of unknown cause. MATERI ALS AND METHODS: Findings from 391 angiographic examinations (323 init ial, 68 repeat) were retrospectively reviewed in 323 patients with non traumatic subarachnoid hemorrhage to determine the cause of bleeding a nd the frequency of complications with neurologic deficit. RESULTS: At the initial angiographic examination, aneurysms were found in 195 pat ients (60.4%), and arteriovenous malformations were found in 11 patien ts (3.4%). Sixty-six patients with negative findings at initial examin ation underwent repeat cerebral angiography. Three additional aneurysm s were detected, all of which could be seen retrospectively on the ini tial angiogram. In 63 patients, the cause of bleeding remained unexpla ined. Complications of the 391 angiographic examinations were definiti ve neurologic deficits in one patient (0.2%) and transient deficits in seven patients (1.8%). CONCLUSION: Repeat angiography is not necessar y in patients with subarachnoid hemorrhage if technically good, carefu lly evaluated digital subtraction angiography was performed initially. Repeat angiography seems to be justified only when the initial examin ation is technically inadequate, when vasospasm is present, or if furt her bleeding occurs.