title: MR angiography follow-up 10 years after cryptogenic nonperimesencephalic subarachnoid hemorrhage.
abstract: OBJECTIVE
  Long-term magnetic resonance angiography (MRA) follow-up studies regarding cryptogenic nonperimesencephalic subarachnoid hemorrhage (nSAH) are scarce. This single-centre study identified all patients with angiographically verified cryptogenic nSAH from 1998 to 2007: The two main objectives were to prospectively assess the incidence of de novo aneurysm with 3.0-MRI years after cryptogenic nSAH in patients without evidence for further hemorrhage, and retrospectively assess patient demographics and outcome.
  
  
  METHODS
  From prospectively maintained report databases all patients with angiographically verified cryptogenic nSAH were identified. 21 of 29 patients received high-resolution 3T-MRI including time-of-flight and contrast-enhanced angiography, 10.2 ± 2.8 years after cryptogenic nSAH. MRA follow-up imaging was compared with initial digital subtraction angiography (DSA) and CT/MRA. Post-hemorrhage images were related to current MRI with reference to persistent lesions resulting from delayed cerebral ischemia (DCI) and post-hemorrhagic siderosis. Patient-based objectives were retrospectively abstracted from clinical databases.
  
  
  RESULTS
  29 patients were identified with cryptogenic nSAH, 17 (59%) were male. Mean age at time of hemorrhage was 52.9 ± 14.4 years (range 4 - 74 years). 21 persons were available for long-term follow-up. In these, there were 213.5 person years of MRI-follow-up. No de novo aneurysm was detected. Mean modified Rankin Scale (mRS) during discharge was 1.28. Post-hemorrhage radiographic vasospasm was found in three patients (10.3%); DCI-related lesions occurred in one patient (3.4%). Five patients (17.2%) needed temporary external ventricular drainage; long-term CSF shunt dependency was necessary only in one patient (3.4%). Initial DSA retrospectively showed a 2 x 2 mm aneurysm of the right distal ICA in one patient, which remained stable. Post-hemorrhage siderosis was detected 8.1 years after the initial bleeding in one patient (4.8%).
  
  
  CONCLUSIONS
  Patients with cryptogenic nSAH have favourable outcomes and do not exhibit higher risks for de novo aneurysms. Therefore the need for long-term follow up after cryptogenic nSAH is questionable.
authors: University Medical Center Mannheim, University of Heidelberg, Department of Neuroradiology, Mannheim, Germany.
authors: Holger
authors: H
authors: Wenz
authors: University Medical Center Mannheim, University of Heidelberg, Department of Neurosurgery, Mannheim, Germany.
authors: Gregory
authors: G
authors: Ehrlich
authors: University Medical Center Mannheim, University of Heidelberg, Department of Neuroradiology, Mannheim, Germany.
authors: Ralf
authors: R
authors: Wenz
authors: University Medical Center Mannheim, University of Heidelberg, Department of Neurosurgery, Mannheim, Germany.
authors: Mohamad-Motaz
authors: MM
authors: Al Mahdi
authors: University Medical Center Mannheim, University of Heidelberg, Department of Neuroradiology, Mannheim, Germany.
authors: Johann
authors: J
authors: Scharf
authors: University Medical Center Mannheim, University of Heidelberg, Department of Neuroradiology, Mannheim, Germany.
authors: Christoph
authors: C
authors: Groden
authors: University Medical Center Mannheim, University of Heidelberg, Department of Neurosurgery, Mannheim, Germany.
authors: Peter
authors: P
authors: Schmiedek
authors: University Medical Center Mannheim, University of Heidelberg, Department of Neurosurgery, Mannheim, Germany.
authors: Marcel
authors: M
authors: Seiz-Rosenhagen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D001921:Brain / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis*; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000175:diagnosis; D055815:Young Adult