title: [Reangiography after perimesencephalic subarachnoid hemorrhage].
abstract: BACKGROUND
  This study aimed to determine the value of digital subtraction angiography (DSA) for the detection of causative vascular lesions in patients with perimesencephalic subarachnoid hemorrhage (SAH) after initially negative noninvasive and invasive neurovascular imaging, such as computed tomography angiography (CTA), DSA and magnetic resonance angiography (MRA).
  
  
  METHODS
  We analyzed the value of repeated DSA for the detection of causative vascular lesions in 750 patients presenting to our institution with SAH and including 30 with a purely perimesencephalic pattern of subarachnoidal hemorrhage and initially negative noninvasive and invasive neurovascular imaging over a 10-year period.
  
  
  RESULTS
  Repeated DSA demonstrated a causative vascular lesion in 1 patient (3.3%) but no causative vascular lesions were detected in the other patients.
  
  
  CONCLUSIONS
  Repeated DSA can be used to detect a source of hemorrhage after initially negative imaging diagnostics in some rare cases. Such a finding has a therapeutic and prognostic impact especially for aneurysms in the posterior circulation which bear a higher risk of renewed hemorrhaging. Therefore, we believe that repeated DSA should be recommended in patients with perimesencephalic SAH even under consideration of the risk of complications caused by a second invasive DSA.
authors.affiliation: Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen, Hufelandstr. 55, 45147 Essen, Deutschland. adrian.ringelstein@uk-essen.de
authors.forename: A
authors.initials: A
authors.lastname: Ringelstein
authors.forename: O
authors.initials: O
authors.lastname: Mueller
authors.forename: O
authors.initials: O
authors.lastname: Timochenko
authors.forename: C
authors.initials: C
authors.lastname: Moenninghoff
authors.forename: U
authors.initials: U
authors.lastname: Sure
authors.forename: M
authors.initials: M
authors.lastname: Forsting
authors.forename: M
authors.initials: M
authors.lastname: Schlamann
mesh_terms: D015901:Angiography, Digital Subtraction / Q000706:statistics & numerical data*; D002533:Cerebral Angiography / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000706:statistics & numerical data*; D008297:Male; D008636:Mesencephalon / Q000098:blood supply / Q000000981:diagnostic imaging*; D015995:Prevalence; D011856:Radiographic Image Enhancement / Q000379:methods; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*