VALUE OF REPEAT ANGIOGRAPHY IN PATIENTS WITH SPONTANEOUS SUBCORTICAL HEMORRHAGE

Background and Purpose-Neuroradiological investigations do not disclos e a source of bleeding in some patients with spontaneous subcortical h emorrhage. These patients may harbor undetected vascular malformations and may be at risk of rebleeding in the future. We investigated patie nts with subcortical hemorrhage with use of repeat angiography and MRI to determine the incidence of occult vascular malformations and the r isk of bleeding during follow-up. Methods-We reviewed a consecutive se ries of 137 patients with subcortical hemorrhage during a 10-year peri od (June 1987 through June 1997). If the patient was <65 years old and the first angiogram and/or MRI did not show a source of bleeding, rep eat angiography was recommended. All angiographic and MRI studies were reviewed. The relationship between the identified bleeding source and clinical variables such as patient age, sex, and history of hypertens ion and the size and location of the hematoma were examined. Results-O ne hundred seven patients (78%) underwent angiography on admission, 10 (7%) had immediate surgery for hematoma without angiography, and 20 ( 15%) had neither angiography nor surgery. Overall, an etiology for the hemorrhage was found in 55 cases (40%). Vascular malformations were c ommon in young patients without preexisting hypertension. A second ang iogram was obtained in 22 patients, and 4 arteriovenous malformations were demonstrated. Rebleeding at the site of the initial hemorrhage wa s not observed after a mean follow-up of 68 months. Conclusions-Angiog raphy performed acutely after hemorrhage may not demonstrate vascular malformations. Consideration should be given to repeat angiography in patients who do not have a specific cause for hemorrhage.