The Clinical Analysis Of 70 Patients Suffered From Subarachnoid Hemorrhage With Negative Cerebral Angiography

Objective: To explore the cause, clinical feature, treatment strategies and prognosis of the negative results of initial cerebral digital subtraction angiography (DSA) or computed tomography angiography (CTA) in the patients with subarachnoid hemorrhage (SAH).Methods: To analyze retrospectively 205 cases in our department of neurosurgery which diagnosis was spontaneous subarachnoid hemorrhage through CT and / or lumbar puncture between February 2004 and February 2009.In which 70 cases were negative results of CTA and / or DSA, 135 cases through CTA and / or DSA, CT examination revealed abnormalities such as intracranial aneurysms, vascular malformations, moyamoya disease and intracranial tumor.In the treatment, angiography negative SAH patients were given the drugs and symptomatic treatment, including bed rest, application sedative, analgesic, laxative drugs, the conventional application of hemostatic drugs, the application of calcium antagonists to suspected of cerebral vasospasm, and given dehydration treatment for patients who had intracranial hypert- ension symptoms; Closely monitor changes of vital signs, check the nervous system everyday; Re-examination of head CT periodically, for patients that the headache symptoms increased or deepening the degree of conscious disturbance given emergency head CT at any time; For angiography negative SAH patients given CTA re-examination again after discharged three to six months later, if still remains negative, this patient will follow-up, for doubtful CTA result given DSA examination. Angiography positive SAH patients were given corresponding treatment for cause.To compare incidence situation and incidence rate of cerebral vasos- pasm, hydrocephalus, neurological dysfunction, rehaemorrhagia, cerebral infarction, death and the patient's number which consistent with Perim- esencephalic Nonaneurysmal Subarachnoid Hemorrhage(PNSAH) by CT examination, respectively, under the premise of negative and positive angiography contrast. And then we made a statistic analysis with chi-square test (χ2), that the value of P is less than 0.05 make sense in statistics (P<0.05).Results: In this group, cerebral angiography negative SAH patients were 70 cases, in which there were 38 cases of male patients, incidence of 54.3 percent, 32 cases of women, incidence of 45.7 percent. cerebral angiography positive SAH patients were 135 cases, in which there were 65 cases of male patients, incidence of 48.1 percent, 70 cases of women, incidence of 51.9 percent(differences of gender P>0.05); Patients with hypertension in negative group were 19 cases, incidence of 27.1 percent, positive group were 40 cases, incidence of 29.6 percent (P>0.05); Patients with diabetes mellitus in negative group were 3 cases, incidence of 4.3 percent, positive group were 15 cases, incidence of 11.1 percent (P>0.05); Patients with smoking history in negative group were 7 cases, incidence of 10 percent, positive group were 32 cases, incidence of 23.7 percent (P<0.05); Patients with Hunt-Hess gradeⅠin negative group were 47 cases, incidence of 67.1 percent, positive group were 6 cases, incidence of 4.4 percent (P<0.05); Patients with Hunt-Hess gradeⅡin negative group were 21 cases, incidence of 30 percent, positive group were 51 cases, incidence of 37.8 percent (P<0.05); Patients with Hunt-Hess gradeⅢin negative group were 2 cases, incidence of 2.9 percent, positive group were 43 cases, incidence of 31.9 percent (P<0.05); Patients with Hunt-Hess gradeⅣin negative group was 0 case, incidence of 0 percent, positive group were 20 cases, incidence of 14.8 percent (P<0.05); Patients with Hunt-Hess gradeⅤin negative group was 0 case, incidence of 0 percent, positive group were 15 cases, incidence of 11.1 percent (P<0.05); Patients had signs of neck rigidity in negative group were 48 cases, incidence of 68.6 percent, positive group were 135 cases, incidence of 100 percent (P<0.05); Patients had symptoms of epilepsy in negative group were 3 cases, incidence of 4.3 percent, positive group were 21 cases, incidence of 15.6 percent (P<0.05); Patients with cranial nerve palsy in negative group were 6 cases, incidence of 8.6 percent, positive group were 10 cases, incidence of 7.4 percent (P<0.05); The average time of intracranial hypertension in negative group were 3.2 days, positive group were 14.5 days (P<0.05); The average time of conscious disturbance in negative group was 0.1 day, positive group were 7.1 days (P<0.05); Patients with cerebral vasospasm in negative group were 6 cases, incidence of 8.6 percent, positive group were 47 cases, incidence of 34.8 percent (P<0.05); Patients had rehaemorrhagia complication in negative group were 0 cases, incidence of 0 percent, positive group were 28 cases, incidence of 20.7 percent (P<0.05); Patients had hydrocephalus complication in negative group were 4 cases, incidence of 5.7 percent, positive group were 23 cases, incidence of 17 percent (P<0.05); Patients had cerebral infarction complication in negative group were 2 cases, incidence of 2.9 percent, positive group were 17 cases, incidence of 12.6 percent (P<0.05); Patients had hyponatremia complication in negative group were 2 cases, incidence of 2.9 percent, positive group were 25 cases, incidence of 18.5 percent (P<0.05); Patients deaths in negative group were 1 cases, incidence of 1.4 percent, positive group were 21 cases, incidence of 15.6 percent (P<0.05); Patients consistent with PNSAH in negative group were 19 cases, incidence of 27.1 percent, positive group were 0 cases, incidence of 0 percent (P<0.05);Conclusions:①This study shows that the first reason of SAH's patients with negative cerebral angiography is mainly due to PNSAH (27.1%), other reasons may be due to thrombosis within the aneurysm, tiny aneurysm or cerebral vasospasm, cavernous angioma, spinal cord arterio- venous malformations (SAVM), blood diseases and so on, a small number of false-negative is also probably;②Smoking patients is fewer, clinical symptoms is mild in the SAH's patients with negative cerebral angiography;③In the treatment, the SAH's patients with negative cerebral angiography need drug or symptomatic treatment only and therapeutic effect is better;④The complication of SAH's patients with negative cerebral angiography is fewer, mortality is lower and prognosis is good.