Likelihood of aneurysmal subarachnoid haemorrhage in patients with normal unenhanced CT, CSF xanthochromia on spectrophotometry and negative CT angiography

A. K. Rana, H. E. Turner, K. A. Deans

Research output: Contribution to journalArticle

3 Citations (Scopus)
4 Downloads (Pure)

Abstract

Background: Patients with suspected subarachnoid haemorrhage, a normal noncontrast computed tomography (CT) and cerebrospinal fluid (CSF) evidence of haemoglobin breakdown products often undergo CT angiography (CTA). If this is normal, then invasive catheter angiography may be offered. In current clinical practice, haemoglobin breakdown products are detected by spectrophotometry rather than visible xanthochromia, and CTA is performed on multidetector scanners. The aim of this study was to determine if such patients should still have a catheter angiography, given the associated risks.
Methods: Patients positive for CSF spectrophotometry (n=26) were retrospectively identified from the clinical biochemistry information system and
imaging data from the electronic radiology records were reviewed. Discharge
letters were consulted to relate the biochemistry and radiology results to the
final diagnosis.
Results: 15 patients with CT angiography were found. Nine patients had normal
CT angiography. No causative aneurysms had been missed. One patient had small, coincidental aneurysms missed on initial reading of the CTA.
Conclusion: The likelihood of a clinically significant aneurysm in a patient who is
CT negative, lumbar puncture positive and CTA negative is low. Double reporting
of negative CT angiograms may be advisable.
Original languageEnglish
Pages (from-to)200-206
Number of pages7
JournalJournal of the Royal College of Physicians of Edinburgh
Volume43
Issue number3
DOIs
Publication statusPublished - 2013

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biochemistry
information system
electronics
evidence

Keywords

  • Angiogram-negative subarachnoid haemorrhage
  • spectrophotometry
  • subarachnoid haemorrhage
  • xanthochromia

Cite this

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title = "Likelihood of aneurysmal subarachnoid haemorrhage in patients with normal unenhanced CT, CSF xanthochromia on spectrophotometry and negative CT angiography",
abstract = "Background: Patients with suspected subarachnoid haemorrhage, a normal noncontrast computed tomography (CT) and cerebrospinal fluid (CSF) evidence of haemoglobin breakdown products often undergo CT angiography (CTA). If this is normal, then invasive catheter angiography may be offered. In current clinical practice, haemoglobin breakdown products are detected by spectrophotometry rather than visible xanthochromia, and CTA is performed on multidetector scanners. The aim of this study was to determine if such patients should still have a catheter angiography, given the associated risks.Methods: Patients positive for CSF spectrophotometry (n=26) were retrospectively identified from the clinical biochemistry information system andimaging data from the electronic radiology records were reviewed. Dischargeletters were consulted to relate the biochemistry and radiology results to thefinal diagnosis.Results: 15 patients with CT angiography were found. Nine patients had normalCT angiography. No causative aneurysms had been missed. One patient had small, coincidental aneurysms missed on initial reading of the CTA.Conclusion: The likelihood of a clinically significant aneurysm in a patient who isCT negative, lumbar puncture positive and CTA negative is low. Double reportingof negative CT angiograms may be advisable.",
keywords = "Angiogram-negative subarachnoid haemorrhage, spectrophotometry, subarachnoid haemorrhage, xanthochromia",
author = "Rana, {A. K.} and Turner, {H. E.} and Deans, {K. A.}",
year = "2013",
doi = "10.4997/JRCPE.2013.303",
language = "English",
volume = "43",
pages = "200--206",
journal = "Journal of the Royal College of Physicians of Edinburgh",
issn = "1478-2715",
publisher = "Royal College of Physicians of Edinburgh",
number = "3",

}

TY - JOUR

T1 - Likelihood of aneurysmal subarachnoid haemorrhage in patients with normal unenhanced CT, CSF xanthochromia on spectrophotometry and negative CT angiography

AU - Rana, A. K.

AU - Turner, H. E.

AU - Deans, K. A.

PY - 2013

Y1 - 2013

N2 - Background: Patients with suspected subarachnoid haemorrhage, a normal noncontrast computed tomography (CT) and cerebrospinal fluid (CSF) evidence of haemoglobin breakdown products often undergo CT angiography (CTA). If this is normal, then invasive catheter angiography may be offered. In current clinical practice, haemoglobin breakdown products are detected by spectrophotometry rather than visible xanthochromia, and CTA is performed on multidetector scanners. The aim of this study was to determine if such patients should still have a catheter angiography, given the associated risks.Methods: Patients positive for CSF spectrophotometry (n=26) were retrospectively identified from the clinical biochemistry information system andimaging data from the electronic radiology records were reviewed. Dischargeletters were consulted to relate the biochemistry and radiology results to thefinal diagnosis.Results: 15 patients with CT angiography were found. Nine patients had normalCT angiography. No causative aneurysms had been missed. One patient had small, coincidental aneurysms missed on initial reading of the CTA.Conclusion: The likelihood of a clinically significant aneurysm in a patient who isCT negative, lumbar puncture positive and CTA negative is low. Double reportingof negative CT angiograms may be advisable.

AB - Background: Patients with suspected subarachnoid haemorrhage, a normal noncontrast computed tomography (CT) and cerebrospinal fluid (CSF) evidence of haemoglobin breakdown products often undergo CT angiography (CTA). If this is normal, then invasive catheter angiography may be offered. In current clinical practice, haemoglobin breakdown products are detected by spectrophotometry rather than visible xanthochromia, and CTA is performed on multidetector scanners. The aim of this study was to determine if such patients should still have a catheter angiography, given the associated risks.Methods: Patients positive for CSF spectrophotometry (n=26) were retrospectively identified from the clinical biochemistry information system andimaging data from the electronic radiology records were reviewed. Dischargeletters were consulted to relate the biochemistry and radiology results to thefinal diagnosis.Results: 15 patients with CT angiography were found. Nine patients had normalCT angiography. No causative aneurysms had been missed. One patient had small, coincidental aneurysms missed on initial reading of the CTA.Conclusion: The likelihood of a clinically significant aneurysm in a patient who isCT negative, lumbar puncture positive and CTA negative is low. Double reportingof negative CT angiograms may be advisable.

KW - Angiogram-negative subarachnoid haemorrhage

KW - spectrophotometry

KW - subarachnoid haemorrhage

KW - xanthochromia

U2 - 10.4997/JRCPE.2013.303

DO - 10.4997/JRCPE.2013.303

M3 - Article

VL - 43

SP - 200

EP - 206

JO - Journal of the Royal College of Physicians of Edinburgh

JF - Journal of the Royal College of Physicians of Edinburgh

SN - 1478-2715

IS - 3

ER -