Clinical Analysis And Long-term Follow-up Of 92cases Of Subarachnoid Hemorrhage With Negative Angiography

Objective:To investigate the clinical and imaging characteristics of patients with angiography negative subarachnoid hemorrhage,and the differences with patients with aneurysmal subarachnoid hemorrhage,and the risk factors for prognosis.Long-term clinical follow-up was conducted to observe the long-term prognosis of patients.Method:404 patients with subarachnoid hemorrhage were admitted in Neurosurgery of General Hospital of Tianjin Medical University during 2011.04-2014.05,311 patients with aneurysmal subarachnoid hemorrhage,and 93 patients with no pathogeny in the first cerebrovascular examination.Three months later,one case was diagnosed as aneurysm by cerebral angiography.92 cases of subarachnoid hemorrhage with unknown causes.We retrospectively these 92 patients with angiography negative subarachnoid hemorrhage,compared with 311 cases of patients with aneurysmal subarachnoid hemorrhage in gender,age,hypertension,diabetes,smoking,Hunt-Hess classification,Fisher classification of CT,WFNS classification,hydrocephalus,cerebral ischemia,death rate,and the modified Rankin scale(MRS)scores at discharge time.These 92 patients patients with angiography negative subarachnoid hemorrhage were classified according to gender,age(≤60years old,> 60 years old),hypertension or not,diabetes or not,whether smoked.The outcome was assessed with modified Rankin Score at discharge.Long-term clinical follow-up was performed for those with good prognosis.Result:There were some differences in risk factors such as hypertension,diabetes and smoking between the negative group and the aneurysm group,but only the difference in hypertension was statistically significant(P<0.05);There were differences in Hunt-Hess grading between the negative group and the aneurysm group,but there was no statistical significance.There were statistically significant differences in Fisher classification of CT and WFNS classification between these two groups(P<0).05);Clinical complications of hydrocephalus and cerebral ischemia were different between the two groups,but there was no statistical significance.At discharge,there were differences in the modified Rankin scale and between the twogroups when discharged,also statistically significant(P<0.05);There was no statistically significant difference in mortality between the two groups.Of the 15 patients with poor prognosis,13 died,including 8 in hospital and 5 in the short term after discharge.Among the 13 patients who died,two were admitted to Hunt and Hess grade 5,4 cases(1 case have secondary bleeding)were grade 4,3 cases were 3grade,4 cases were 2 grade.In the death patients of Hunt-Hess grade 2,1 patient had previous history of liver cirrhosis,liver cancer and coagulation dysfunction,during hospitalization complicated with pleural effusion,atelectasis,and hypoproteinemia;1patient had pancreatitis and intestinal obstruction during hospitalization;1 patient was complicated with thrombocytopenia;1 patient was found with tuberculous meningitis.Among the 15 patients with poor prognosis,the other 2 patients were admitted to the Hunt-Hess grade 2,1 with pulmonary embolism,MRS 4 when discharged,1 with hydrocephalus,MRS 3 when discharged.In this study,92 cases of SAH patients with unknown causes,1 case of secondary hemorrhage,accounting for 1.1%;2 cases of cerebral ischemia,accounting for about 2.2%(including 1 case of basal ganglia infarction and 1 case of transient ischemia).Two cases of hydrocephalus,about 2.2%,did not require ventriculoperitoneal shunt.There was a correlation between the age、the history of hypertension and poor prognosis in patients with angiography negative subarachnoid hemorrhage,and there was no significant with gender,history of diabetes and smoking history;In 62 patients(MRS 0-1 when discharged)who were successfully followed up,One patient died of heart disease,One patient had chronic subdural hematoma,Three patients had cerebral infarction,No patient had rebleeding.Conclusion : The prognosis of SAH patients with unknown causes was generally better than that of aneurysmal subarachnoid hemorrhage,but complications such as rebleeding,cerebral ischemia and hydrocephalus still existed.Hypertension and advanced age are the risk factors for the prognosis of patients with angiography negative subarachnoid hemorrhage;The long-term prognosis of MRS 0-1 patients is good.