University of Oulu

Achrén, A., Raj, R., Siironen, J. et al. Spontaneous angiogram-negative subarachnoid hemorrhage: a retrospective single center cohort study. Acta Neurochir 164, 129–140 (2022).

Spontaneous angiogram-negative subarachnoid hemorrhage : a retrospective single center cohort study

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Author: Achrén, Alexander1; Raj, Rahul1; Siironen, Jari1;
Organizations: 1Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Töölö Hospital, HUS, Topeliuksenkatu 5, PO. Box. 266, 00029, Helsinki, Finland
2Division of Clinical Neuroscience, Department of Neurosurgery, University of Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
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Language: English
Published: Springer Nature, 2022
Publish Date: 2022-03-08


Background: Spontaneous angiogram-negative subarachnoid hemorrhage (SAH) is considered a benign illness with little of the aneurysmal SAH-related complications. We describe the clinical course, SAH-related complications, and outcome of patients with angiogram-negative SAH.

Methods: We retrospectively reviewed all adult patients admitted to a neurosurgical intensive care unit during 2004–2018 due to spontaneous angiogram-negative SAH. Our primary outcome was a dichotomized Glasgow Outcome Scale (GOS) at 3 months. We assessed factors that associated with outcome using multivariable logistic regression analysis.

Results: Of the 108 patients included, 84% had a favorable outcome (GOS 4–5), and mortality was 5% within 1 year. The median age was 58 years, 51% were female, and 93% had a low-grade SAH (World Federation of Neurosurgical Societies grading I–III). The median number of angiograms performed per patient was two. Thirty percent of patients showed radiological signs of acute hydrocephalus, 28% were acutely treated with an external ventricular drain, 13% received active vasospasm treatment and 17% received a permanent shunt. In the multivariable logistic regression model, only acute hydrocephalus associated with unfavorable outcome (odds ratio = 4.05, 95% confidence interval = 1.05–15.73). Two patients had a new bleeding episode.

Conclusion: SAH-related complications such as hydrocephalus and vasospasm are common after angiogram-negative SAH. Still, most patients had a favorable outcome. Only acute hydrocephalus was associated with unfavorable outcome. The high rate of SAH-related complications highlights the need for neurosurgical care in these patients.

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Series: Acta neurochirurgica
ISSN: 0001-6268
ISSN-E: 0942-0940
ISSN-L: 0001-6268
Volume: 164
Issue: 1
Pages: 129 - 140
DOI: 10.1007/s00701-021-05069-7
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: Open Access funding provided by University of Helsinki including Helsinki University Central Hospital. RR has received personal research grants from Finska Läkaresällskapet och Medicinska Understödsföreningen Liv & Hälsa.
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