Value of repeat angiography in patients with spontaneous subcortical hemorrhage.
OBJECTIVE
Neuroradiological investigations do not disclose a source of bleeding in some patients with spontaneous subcortical hemorrhage. These patients may harbor undetected vascular malformations and may be at risk of rebleeding in the future. We investigated patients with subcortical hemorrhage with use of repeat angiography and MRI to determine the incidence of occult vascular malformations and the risk of bleeding during follow-up.


METHODS
We reviewed a consecutive series of 137 patients with subcortical hemorrhage during a 10-year period (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, repeat 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 hypertension and the size and location of the hematoma were examined.


RESULTS
One 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 common in young patients without preexisting hypertension. A second angiogram was obtained in 22 patients, and 4 arteriovenous malformations were demonstrated. Rebleeding at the site of the initial hemorrhage was not observed after a mean follow-up of 68 months.


CONCLUSIONS
Angiography 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.
Hino
A
A
Department of Neurosurgery, Saiseikai Shigaken Hospital, Shiga, Japan.
Fujimoto
M
M
Yamaki
T
T
Iwamoto
Y
Y
Katsumori
T
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography / Q000592:standards*; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D002648:Child; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000601:surgery; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged