Yield of catheter angiography after computed tomography negative, lumbar puncture positive subarachnoid hemorrhage [corrected].
Yield of catheter angiography after computed tomography negative, lumbar puncture positive subarachnoid hemorrhage [corrected].
复制标题
计算机断层扫描阴性、腰椎穿刺阳性蛛网膜下腔出血后导管血管造影的产量[已纠正]。
DOI：
10.1161/strokeaha.113.001234
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发表时间：
2013
期刊：
影响因子：
8.3
通讯作者：
Derdeyn,ColinP
中科院分区：
文献类型：
--
作者：
Wallace,AdamN;Dines,JeffreyN;Zipfel,GregoryJ;Derdeyn,ColinP
背景和目的怀疑动脉瘤性蛛网膜下腔出血（SAH）的患者最初通过非对比头部计算机断层扫描进行评估。如果计算机断层扫描结果为阴性，但临床对SAH的担忧很高，则通常进行腰椎穿刺并进行脑脊液分析。本研究的目的是评估脑脊液黄染和红细胞增多症对动脉瘤性SAH的准确性。方法回顾2002年7月至2012年4月在Barnes Jewish医院接受导管血管造影的所有患者的医疗记录，这些患者在计算机断层扫描阴性和腰椎穿刺怀疑为SAH后，临床怀疑为脑动脉瘤破裂。记录每个病例的脑脊液分析结果、血管造影结果和预后。结果共鉴定出57例患者。在黄色症患者中发现了两个血管造影病变（2/24例，即8.3%），这两个病变均被确认为破裂。非清除性红细胞增多症和无黄色症患者的诊断率为6.3%（1/16例患者），尽管这种病变不被认为是SAH的来源。结论计算机断层扫描阴性但可疑腰椎穿刺的患者应行导管血管造影，特别是有黄色症的患者。仅对红细胞增多症患者进行血管造影的益处尚不清楚，值得进一步研究。
Background and PurposePatients suspected of having aneurysmal subarachnoid hemorrhage (SAH) are initially evaluated with noncontrast head computed tomography. If the computed tomography is negative, but clinical concern for SAH is high, a lumbar puncture with cerebrospinal fluid analysis is typically performed. The purpose of this study was to evaluate the accuracy of cerebrospinal fluid xanthochromia and erythrocytosis for aneurysmal SAH.MethodsMedical records of all patients who underwent catheter angiography at Barnes Jewish Hospital between July 2002 and April 2012 for clinical suspicion of a ruptured brain aneurysm after a negative computed tomography scan and a lumbar puncture suspicious for SAH were reviewed. The cerebrospinal fluid analysis results, angiographic findings, and outcomes of each case were recorded.ResultsFifty-seven patients were identified. Two angiographic lesions were identified in patients with xanthochromia (2/24 patients, ie, 8.3%), both of which were confirmed to have ruptured. The diagnostic yield in patients with nonclearing erythrocytosis and no xanthochromia was 6.3% (1/16 patients), although this lesion was not considered the source of SAH.ConclusionsCatheter angiography should be performed in patients with computed tomography negative but suspicious lumbar puncture, particularly in the presence of xanthochromia. The benefit of angiography in patients with erythrocytosis only is unclear and deserves future study.