Predictors of the Subarachnoid Hemorrhage of a Negative CT Scan
2010; Lippincott Williams & Wilkins; Volume: 41; Issue: 10 Linguagem: Inglês
10.1161/strokeaha.109.574038
ISSN1524-4628
Autores Tópico(s)Vascular Malformations Diagnosis and Treatment
ResumoHomeStrokeVol. 41, No. 10Predictors of the Subarachnoid Hemorrhage of a Negative CT Scan Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBPredictors of the Subarachnoid Hemorrhage of a Negative CT Scan Dao-Ming Tong, MD Ye-Ting Zhou Dao-Ming TongDao-Ming Tong Department of Neurology, Shuyang People's Hospital, Shuyang, China, and Department of Neurology, The Affiliated Pingxiang Hospital, Southern Medical University, Pingxiang, China Ye-Ting ZhouYe-Ting Zhou Shuyang People's Hospital, Shuyang, China Originally published12 Aug 2010https://doi.org/10.1161/STROKEAHA.109.574038Stroke. 2010;41:e566–e567Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: August 12, 2010: Previous Version 1 To the Editor:A good-quality head CT scan will reveal subarachnoid hemorrhage (SAH) in 93% of cases within 24 hours and in >98% of cases within 12 hours after the onset of symptoms.1,2 Because of rapid clearance of blood, delayed head CT scanning may be normal despite a suggestive history.3 However, the recently published guidelines by the American Heart Association do not involve the predictors of the SAH on a negative CT scan.4 This study sought to determine the predictors of the SAH on a negative CT scan.An inception cohort consisted of 367 patients with SAH admitted to the hospital between August 1995 and December 2008. Third-generation CT scanners were used in all patients. The diagnosis of SAH was established on the basis of admission CT scans or by xanthochromia of the cerebrospinal fluid if the CT scan was negative. The patients with a negative CT scan were divided into an emergency CT scan-negative group (0 to 3 days of onset) and a nonemergency CT scan-negative group (4 to 14 days of onset) and 32 patients were randomized who had SAH according to a positive CT scan (control group) and compared individually. Multiple logistic regression was used to identify predictors of SAH of a negative CT scan. Spearman rank correlation was used to analyze the delayed the time of head CT scan in relation to the score of the CT rating scale.Twenty-three of the 367 patients who had SAH on a negative CT scan were diagnosed by lumbar puncture. Of those, 3.3% (12 of 367) patients were in the emergency CT scan-negative group and 3.0% (11 of 327) patients were in the nonemergency CT scan-negative group. Baseline characteristics of the patients are given in the Table. A multiple logistic regression showed that low Hunt Hess grade (OR, 0.141; 95% CI, 0.031 to 0.636; P=0.011) and normal diastolic blood pressure (OR, 0.917; 95% CI, 0.852 to 0.986; P=0.020) were independent predictors of SAH on a negative emergency CT scan. Delaying the time of CT scan (OR, 3.701; 95% CI, 1.419 to 9.650; P=0.007) was an independent predictor of SAH in the nonemergency CT scan-negative group. Furthermore, there was a significant negative correlation between the time of the head CT scan in the nonemergency CT scan-negative group and the SAH CT rating scale score (r=−0.677, P=0.000). Table. Patient Characteristics (Univariate Analyses of Patients)VariablesEmergency CT Scan (Negative) (N=12)Nonemergency CT Scan (Negative) (N=11)Control Group (N=32)Compared with the control group:*P<0.05;†P<0.01.SBP indicates systolic blood pressure; DBP, diastolic blood pressure; GCS, Glasgow Coma Scale; CTRS, Columbia SAH CT Rating Scale.Age, years (mean±SD)51.5±14.354.1±15.357.4±12.1Male sex (%)8 (66.7)6 (50.0)16 (50.0)Time of CT scan, days (mean±SD)1.5±1.07.6±3.3†1.5±1.6Sudden headache (%)11 (91.7)10 (90.9)28 (87.5)Vomiting (%)10 (83.3)8 (72.7)*31 (96.9)Meningismus (%)10 (83.3)*9 (81.8)*32 (100.0)SBP, mm Hg (mean±SD)139.7±21.8141.4±24.4153.4±33.5DBP, mm Hg (mean±SD)76.4±10.5†85.1±13.391.1±16.8Cerebral infarct (%)1 (8.3)4 (32.1)9 (28.1)Hydrocephalus (%)2 (16.7)0 (0)*11 (34.4)Hunt-Hess gradeI to III (100.0)†I to III (100.0)†II to V (100.0) Mild headache4 (33.3)4 (36.4)0 (0) Severe headache, cranial nerve palsy6 (50.0)3 (27.3)14 (43.8) Confusion or lethargy2 (16.7)4 (36.4)11 (34.4) Stupor0 (0)0 (0)5 (15.6) Coma0 (0)0 (0)2 (6.3)GCS score (mean±SD)14.5±0.9*14.5±1.812.4±3.4CTRS score (mean±SD)0±0†0±0†2.5±1.2Rebleed (%)1 (8.3)2 (1.8)7 (21.9)30-day deaths (%)1 (8.3)1 (9.1)9 (28.0)Despite improvements in diagnostic imaging, CT may be less sensitive in patients with SAH presenting with so-called "minor leaks" or normal neurological status.2,5 Therefore, lumbar puncture should be performed in any patient with suspected SAH and negative or equivocal results on CT scan.6 SAH on a negative CT scan may be predicted by a low Hunt Hess grade, normal diastolic blood pressure, and delayed time of the CT scan on admission. The most likely explanation of this finding is that some patients have only a small amount of blood on an initial CT and in sporadic patients, the extravasation might be too small to be detected.2 The delayed time of the head CT scan was negatively related to the CT rating scale scores. The most logical explanation for this relationship is that a small amount of blood or "minor leaks" may disappear too fast to be detected on head CT if the patient presents a delayed time for a head CT scan.DisclosuresNone.1 Sames TA, Storrow AB, Finkelstein JA, Magoon MR. Sensitivity of new-generation computed tomography in subarachnoid hemorrhage. Acad Emerg Med. 1996; 3: 16–20.CrossrefMedlineGoogle Scholar2 Van der Wee N, Rinkel GJE, Hasan D, van Gijn J. Detection of subarachnoid haemorrhage on early CT: is lumbar puncture still needed after a negative scan? J Neurol Neurosurg Psychiatry. 1995; 58: 357–359.CrossrefMedlineGoogle Scholar3 Bambakidis NC, Selman WR. Subarachnoid hemorrhage. In: Suarez JI, ed. Critical Care Neurology and Neurosurgery. Totowa, NJ: Humana Press; 2004: 365–377.Google Scholar4 Bederson JB, Connolly ES Jr, Batjer HH, Dacey RG, Dion JE, Diringer MN, Duldner JE Jr, Harbaugh RE, Patel AB, Rosenwasser RH. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a Special Writing Group of the Stroke Council, American Heart Association. Stroke. 2009; 40: 994–1025.LinkGoogle Scholar5 Adams HP Jr, Kassell NF, Torner JC, Sahs AL. CT and clinical correlations in a recent aneurysmal subarachnoid haemorrhage: a preliminary report of the cooperative aneurysm study. Neurology. 1983; 33: 981–988.CrossrefMedlineGoogle Scholar6 Suarez JI, Tarr RW, Selman WR. Aneurysmal subarachnoid hemorrhage. N Engl J Med. 2006; 354: 387–396.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Young G (2014) The comatose patient: neurological aspects Handbook of ICU Therapy, 10.1017/CBO9781107323919.033, (391-402) (2014) Specific problems Handbook of ICU Therapy, 10.1017/CBO9781107323919.024, (261-460) Wang G, Zhou Y, Chen X, Wang H, Yang T, Chang C, Wang Y, Gu H and Tong D (2012) Acute headache in general neurology of China: Cause changes and predictors of short-term outcome, World Journal of Neuroscience, 10.4236/wjns.2012.22014, 02:02, (98-102), . Zhou Y, Tong D, Wang G, Chen X, Yang T, Wang Y and Gu H (2012) Long-Term Outcome in Patients with Subarachnoid Hemorrhage with Negative CT Scan, CNS Neuroscience & Therapeutics, 10.1111/j.1755-5949.2012.00374.x, 18:10, (870-872), Online publication date: 1-Oct-2012. Zhou Y and Tong D (2011) A minor perimesencephalic subarachnoid hemorrhage on CT changes, World Journal of Neuroscience, 10.4236/wjns.2011.12004, 01:02, (28-30), . Hanuska J and Klener J (2021) Two Similar Cases of a Misdiagnosed Anterior Communicating Aneurysm Rupture, Case Reports in Neurology, 10.1159/000514242, 13:1, (218-224) October 2010Vol 41, Issue 10 Advertisement Article InformationMetrics https://doi.org/10.1161/STROKEAHA.109.574038PMID: 20705932 Originally publishedAugust 12, 2010 PDF download Advertisement
Referência(s)