Subarachnoid Hemorrhage with a Cerebral Aneurysm not Recognized at Conventional Angiography: A Retrospective Study

腦血管攝影檢查未能發現的動脈瘤破裂所引起的蛛網膜下腔出血：回溯性研究

顧逸康(Yi-Kang Ku) ； 黃浩輝(Ho-Fai Wong) ； 李國維(Kwo-Whei Lee) ； 黃耀祥(Yon-Cheong Wong) ； 秦嗣騏(Shy-Chyi Chin)

《中華放射線醫學雜誌》 35卷4期 (2010/12) Pp. 201-208

摘要

調查初次腦血管攝影未能診斷動脈瘤的原因。
在160位診斷為動脈瘤破裂所致蛛網膜下腔出血病例中，找到6位在首次腦血管攝影檢查未能找到原因的病患。我們以標準的腦血管攝影步驟與第二次血管攝影檢查的發現，試圖找出在首次腦血管攝影檢查未能找到動脈瘤的原因。
首次腦血管攝影檢查未能找到出血動脈瘤的原因有：誤判與不完全的操作程序(4/6)，疑似動脈瘤血栓或血管痙攣而遮蔽了動脈瘤(3/6)，水泡狀的動脈瘤(1/6)。在兩個病例中存在有多重的原因。
如果在臨床上懷疑是因動脈瘤破裂所造成的蛛網膜下腔出血，我們建議在首次腦血管攝影沒有異常發現的病例，必須要考慮是否有以上所述的3個可能原因，以做為是否要重複施行腦血管攝影的參考。

並列摘要

To investigate the possible causes of a false-negative initial cerebral digital subtract ionangiography (DSA) of aneurysmal subarachnoid hemorrhage (SAH).
Six initially unrecognized ruptured aneurysms were reviewed from among approximately 160 aneurysmal SAH cases collected from the medical records. The standard angiographic procedure and findings on repeat DSA were used to identify the possible causes. The initial DSA was reviewed and the false-negative impression resulted from an initial overlooking with or without incomplete procedure (4/6), presumed thrombosis or vasospasm with no recognized aneurysm, even when reviewed retrospectively (3/6), and the presence of a blister aneurysm (1/6). Two of the six cases had multiple causes.
Whenever the DSA is negative in a patient strongly suspected of an aneurysmal SAH, the three above-mentioned causes should be considered and repeat DSA in the proper clinical setting is recommended.