title: Repeated digital substraction angiography after perimesencephalic subarachnoid hemorrhage?
abstract: OBJECTIVE
  In patients with perimesencephalic subarachnoid hemorrhage (pSAH) DSA is recommended to exclude aneurysms to due false negative findings in CT-angiography. However, whether a second DSA is indicated during the clinical course to exclude--in addition to aneurysms--fistulas, too, is still under debate. We aimed to evaluate the benefit of repeated DSA in patients with pSAH.
  
  
  METHODS
  The source of data was a prospective database set up at the neurological, neurosurgical and neuroradiological departments in our institution. A total of 69 patients with pSAH were enrolled and analyzed by reviewing the medical records and neuroradiological findings.
  
  
  RESULTS
  68 patients presented with Hunt & Hess Grade I-II and one patient with Hunt & Hess Grade III. Median in-hospital stay was 8 days (3-22). In 2 patients mild vasospasm were diagnosed. DSA was performed in all patients at least once. DSA was repeated in 38 patients (55%) after a median of 7 (3-21) days. None of the repeated DSA did show any additional distinctive features with respect to the first DSA.
  
  
  CONCLUSIONS
  In our opinion the procedure of repeating DSA in patients with pSAH is likely to become obsolete. One DSA should be performed prior to discharge--and subsequent to possible vasospasm--to exclude hemorrhage caused by aneurysms of the posterior circulation mimicking a perimesencephalic SAH pattern.
authors.affiliation: Department of Neuroradiology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany. hagen.huttner@neuro.imed.uni-erlangen.de
authors.forename: H B
authors.initials: HB
authors.lastname: Huttner
authors.forename: M
authors.initials: M
authors.lastname: Hartmann
authors.forename: M
authors.initials: M
authors.lastname: Köhrmann
authors.forename: M
authors.initials: M
authors.lastname: Neher
authors.forename: C
authors.initials: C
authors.lastname: Stippich
authors.forename: S
authors.initials: S
authors.lastname: Hähnel
authors.forename: B
authors.initials: B
authors.lastname: Kress
mesh_terms: D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography / Q000379:methods*; D003287:Contrast Media; D006801:Humans; D007479:Iopamidol / Q000031:analogs & derivatives; D008636:Mesencephalon / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol