title: Diagnostic yield of cerebral angiography in patients with computed tomography-negative, lumbar puncture-positive subarachnoid hemorrhage.
abstract: BACKGROUND
  Cerebral angiography is generally recommended in patients with subarachnoid hemorrhage (SAH) by positive lumbar puncture (LP) but negative findings on computed tomography (CT). Existing data on the yield of angiography in these patients are very limited.
  
  
  OBJECTIVE
  To retrospectively assess the diagnostic yield of cerebral angiography in patients with CT-/LP+ SAH and to determine the clinical and laboratory predictors of a vascular abnormality on angiography.
  
  
  METHODS
  A total of 35 patients with CT-/LP+ SAH underwent cerebral angiography at our institution between 2008 and 2011. Patient clinical characteristics and LP findings were entered into a multivariate logistic regression analysis to identify predictors of vascular abnormalities.
  
  
  RESULTS
  Twenty-five patients (71.4%) were female and 10 (28.6%) were male, with a mean age of 53 years. Twenty-six patients (74.3%) had cerebrospinal fluid xanthochromia. Sixteen patients (45.7%) were found to have an aneurysm on cerebral angiography. The median CSF red blood cell count of both the first (7790/mm(3) vs 4700/mm(3)), and last collection tubes (6800/mm(3) vs 3219/mm(3)) were higher in patients with cerebral aneurysms vs those without aneurysms (P = .3). On multivariate analysis, there were no clinical or laboratory parameters that predicted the presence of aneurysm on cerebral angiography.
  
  
  CONCLUSIONS
  The diagnostic yield of cerebral angiography is high (45.7%) in patients with CT-/LP+ SAH. Higher red blood cell counts were noted in patients with cerebral aneurysms but no clinical or laboratory parameter can reliably predict the presence of a vascular anomaly. Thus, it is reasonable to perform cerebral angiography in all patients with CT-/LP+ SAH.
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.
authors.forename: Nohra
authors.initials: N
authors.lastname: Chalouhi
authors.forename: Samantha
authors.initials: S
authors.lastname: Witte
authors.forename: David L
authors.initials: DL
authors.lastname: Penn
authors.forename: Pranay
authors.initials: P
authors.lastname: Soni
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
authors.forename: L Fernando
authors.initials: LF
authors.lastname: Gonzalez
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Dumont
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenwasser
authors.forename: Stavropoula
authors.initials: S
authors.lastname: Tjoumakaris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013129:Spinal Puncture; D013345:Subarachnoid Hemorrhage / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D055815:Young Adult