Spinal vascular malformations in non-perimesencephalic subarachnoid hemorrhage.
OBJECTIVE
In patients with non-traumatic subarachnoid hemorrhage (SAH) and no evidence for a cerebral aneurysm on angiography, a frequent cause of the hemorrhage is perimesencephalic hemorrhage or other cerebral vascular pathology. In some patients no cause is found. The exact incidence of a spinal vascular malformation (SVM) as the origin for the SAH is not known. We assessed the occurrence of SVM in angiogram-negative, non-perimesencephalic subarachnoid hemorrhage (NPSAH).


METHODS
47 patients (from a consecutive cohort of 632) were identified with an angiogramnegative, non-perimesencephalic subarachnoid hemorrhage and 42 of these were analyzed by performing MR-imaging of the complete spinal neuraxis with additional spinal angiography on indication.


RESULTS
In four patients a spinal vascular malformation was identified as the cause of the SAH, indicating an incidence of 9 % of SVM in NPSAH, and an incidence of 1 % of SVM in all patients with SAH.


CONCLUSIONS
Systematic analysis of angiogram-negative, non-perimesencephalic subarachnoid hemorrhage by MR imaging of the complete spinal neuraxis yields a higher incidence of SVM than previously documented. We recommend MR imaging of the complete spinal neuraxis in patients with a non-perimesencephalic subarachnoid hemorrhage in whom no cause for the hemorrhage has been found.
Germans
M R
MR
Department of Neurosurgery, Neurosurgical Center Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. M.R.Germans@amc.uva.nl
Pennings
F A
FA
Sprengers
M E S
ME
Vandertop
W P
WP
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008636:Mesencephalon / Q000098:blood supply / Q000473:pathology; D011446:Prospective Studies; D012189:Retrospective Studies; D013116:Spinal Cord / Q000002:abnormalities* / Q000098:blood supply / Q000473:pathology; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis* / Q000209:etiology*; D054079:Vascular Malformations / Q000150:complications* / Q000175:diagnosis*; D055815:Young Adult