Neurobehavioral sequelae of SAH without a proven source of the bleeding in comparison to the sequelae of the rupture of an intracranial aneurysm

Abstract

In 15–22% of all cases of non-traumatic spontaneous SAH a source of the bleeding cannot be identified even after repeated angiography (Cioffi et al., 1989; Alexander, Dias and Uttley, 1986; Spallone et al., 1986; Brismar and Sundbârg, 1985; Eskesen et al., 1984; Nishioka et al, 1984). Ferbert, Hubo and Biniek (1992) found in 38 of 91 patients after spontaneous nontraumatic SAH without a proven source of the bleeding (NA-SAH) a preponderant or exclusive distribution of blood in the prepontine and/or interpeduncular cistern. Ruelle et al. (1985) reported on an essentially more favorable course in 49 NA-SAH patients in comparison to patients after aneurysm rupture. Clinically relevant, angiographically proven vasospasm only occurred in 24.5% of the NA-SAH patients. Upon discharge only one patient presented with a hemiparesis and an aphasia (Ruelle et al., 1985). At follow-up 1–15 (median 8) years later, 94% of the patients were able to work to the same extent as before the hemorrhage.