Clinical analysis of patients with spontaneous subarachnoid hemorrhage and a negative result in the first digital subtraction angiography

Objective To investigate the etiology,diagnosis and treatment strategy for patients with spontaneous subarachnoid hemorrhage( SAH) and a negative result in the first digital subtraction angiography( DSA). Methods The clinical data were retrospectively evaluated in 50 patients,who were treated in the First Affiliated Hospital of Dalian Medical University with a negative result of DSA examined within a week after onset. Results Upon reexamination,10 cases had positive results,including 5 cases of aneurysm,3 cases of occult vascular malformations and 2 cases of cavernous hemangioma. Among them,9 cases were cured by surgery or embolization; another one were cured after gamma knife treatment. The other 40 patients received non- operative treatment; 39 cases were cured and 1 patients died due to combination with severe internal medicine disease. Conclusions Patients with the first time negative DSA should be paid more attention and taken to the second DSA or MRI actively. However,for patients who were diagnosed with PNSH,we suggest to avoid the second DSA,but they must be followed up with CTA or MRI.