4-vessels angiography: a tinkering tool in multi-faceted manner.

Al-Khawaldeh Maher; Al Jfoot Samer; Al-lozi Rakan; Al dalahmeh Ala'; Haddad Firas; Alqroom Rami; Al afashat Manar; Elayan Abeer; Younes Basel; Al Shurbaji Amer.

Volume : VIII, Issue : III, March - 2019

4-vessels angiography: a tinkering tool in multi-faceted manner.

Al Khawaldeh Maher, Al Jfoot Samer, Al Lozi Rakan, Al Dalahmeh Ala , Haddad Firas, Alqroom Rami, Al Afashat Manar, Elayan Abeer, Younes Basel, Al Shurbaji Amer.

Abstract :

Introduction: The global incidence of spontaneous intracranial vascular conditions such as: Spontaneous Subarachnoid hemorrhage (SAH); Non–aneurysmal subarachnoid hemorrhage (NASAH); and arterio–vascular malformation, which are low incidence conditions though lethal pathologies due to leakage of blood within the cranial cavity. Missed such conditions are mutual agony among healthcare providers. Management of these pathologies is imperative to an early diagnosis. Stimulatingly, despite the reiterated imaging studies that have been established for diagnosing intracranial vascular pathologies, 4–vessels angiography had ranked superior multidimensionally.

Thus, this study targets to address the diagnostic significance of angiography in spontaneous intracranial hemorrhages as the cardinal tool of management with reference point comparison of our findings with those reported in literature.

Methods: A retrospective chart review of patients presented with spontaneous intracranial hemorrhages over a period of 3–years from January 2014 till January 2017 at the neurosurgical department of King Hussein Medical Center was conducted. All patients had clinical features of sudden onset of severe headache, decrease level of consciousness of sudden neurological deficit, who were hospitalized within 72–hours after the bleeding onset. Clinical data, non–invasive radiological imaging studies confirmed the spontaneous intracranial hemorrhages presence. Patients underwent subsequent diagnostic workup. The results and complications of the Digital subtraction angiography (DSA) study were analyzed. Repeated DSA or computed tomography angiography (CTA) was performed 6–8 weeks later if initial angiographic result were negative.

Results: Of 141–patients who underwent cereal angiography following spontaneous subarachnoid hemorrhage in the three–year time period, 81–females (57.47%), 60–males (42.55%), mean age 50.76 year. Fifty four examinations revealed aneurysms, another 26– small aneurysms were diagnosed in the angiogram negative cases on the follow–up studies. Eighteen patients had non–aneurysmal subarachnoid haemorrhage, fourteen–case showed arteriovenous malformation (AVM) and five–case showed dural fistula.

Sixty–seven percent of the patients classified their headache as being the worst headache of their life and approximately 54 % described maximum intensity of the pain within the first 2–hours. Sudden loss of consciousness (LOC) occurred in 42% of the patients due to increased intracranial pressure. LOC often is transitory; however, approximately 15 % of the patients remained comatosed for several days. Seizures during the acute phase occurred in 16–patients (11.35%).

Conclusion: Spontaneous intracranial hemorrhages is a devastating and multifarious disease which must be managed in well– established and dedicated centers. In our center, DSA following non–conclusive CT imaging of the ain was therefore a test of extremely high yield, utility, and also associated with decreased morbidity and mortality. Non–aneurysmal SAH cases have better neurological status compared with aneurysmal cases.