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Computed Tomographic Angiography for the Evaluation of Aneurysmal Subarachnoid Hemorrhage
Author(s) -
Carstairs Shaun D.,
Tanen David A.,
Duncan Timothy D.,
Nordling Olaf B.,
Wanebo John E.,
Paluska Thomas R.,
Theodore Nicholas,
Riffenburgh Robert H.
Publication year - 2006
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1197/j.aem.2005.12.010
Subject(s) - medicine , subarachnoid hemorrhage , radiology , computed tomographic angiography , aneurysm , angiography , computed tomography angiography , cerebral angiography , lumbar puncture , cerebrospinal fluid , surgery
Objectives:Computed tomography (CT) followed by lumbar puncture (LP) is currently the criterion standard for diagnosing subarachnoid hemorrhage (SAH) in the emergency department (ED); however, this is based on studies involving a limited number of patients. The authors sought to assess the ability of CT angiography (CTA), a new diagnostic modality, in conjunction with CT/LP to detect SAH.Methods:Consecutive patients presenting to the ED with symptoms concerning for SAH were approached. All patients had an intravenous catheter placed and underwent a noncontrast head CT followed by CTA. Patients whose CT did not reveal evidence of SAH or other pathology underwent LP in the ED. CTAs were read within 24 hours by a neuroradiologist blinded to the patient's history.Results:A total of 131 patients were approached, 116 were enrolled, and 106 completed the study. In six of 116 patients (5.1%), aneurysm was found on CTA with normal CT and positive findings on LP; three had a positive CTA with normal CT and LP findings (one of which had a negative cerebral angiogram), and there was one false‐positive CTA. Follow‐up of all 131 patients showed no previously undiagnosed intracranial pathology. In this patient population, 4.3% (5/116) were ultimately found to have an SAH and/or aneurysm.Conclusions:In this pilot study, CTA was found to be useful in the detection of cerebral aneurysms and may be useful in the diagnosis of aneurysmal SAH. A larger multicenter study would be useful to confirm these results.