• Ming Y Chong, Sean C Martin, Isaac Phang, E J St George, Nigel Suttner, and Mario K Teo.
• Institute of Neurological Science, Queen Elizabeth University Hospital, Glasgow, United Kingdom; Medical School, University of Glasgow, Glasgow, United Kingdom.
• World Neurosurg. 2018 Mar 1; 111: e355-e361.

ObjectiveTo determine prevalence of cerebrovascular abnormalities in diagnostic subgroups of spontaneous subarachnoid hemorrhage (SAH) in a regional neurosurgical center in the modern era.MethodsData of 609 consecutive patients with spontaneous SAH in a 3-year period (August 2010 to August 2013) were prospectively collected. Patients were divided into 3 diagnostic subgroups: computed tomography (CT) positive for SAH; CT negative but positive cerebrospinal fluid examination by spectrophotometry for SAH; CT negative for SAH and inconclusive cerebrospinal fluid examination. All patients fit for intervention underwent CT angiography with or without digital subtraction angiography to identify vascular abnormalities for subsequent treatment.ResultsOf 609 patients, 554 were fit for further investigation and consideration of further intervention; 514 patients had confirmed SAH. Mean patient age was 54.0 years; 61.5% of patients were women. Of patients, 390 (75.9%) showed vascular abnormalities on angiography. There were 438 patients (85.2%) with confirmed SAH diagnosed on CT scan (group 1). Vascular abnormalities were detected in 81.1% of patients; 18.9% of patients with positive CT scan had no identifiable cause of SAH. Of patients with confirmed SAH, 76 (14.8%) had negative CT scan but positive lumbar puncture (group 2); 46.1% of patients in this group had vascular abnormalities. Three patients with inconclusive cerebrospinal fluid examination had lesions requiring treatment. Median length of hospital stay in group 1 patients was longer than median length of hospital stay in group 2 patients.ConclusionsFrequency of vascular abnormalities in spontaneous SAH is lower than the traditionally quoted figure, which has diagnostic and prognostic implications for patient management.Copyright © 2017 Elsevier Inc. All rights reserved.

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