Computed Tomographic Angiography for the Evaluation of Aneurysmal Subarachnoid Hemorrhage

Shaun D. Carstairs, David A. Tanen, Timothy D. Duncan, Olaf B. Nordling, John E. Wanebo, Thomas R. Paluska, Nicholas Theodore, Robert H. Riffenburgh

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)486-492
Number of pages7
JournalAcademic Emergency Medicine
Volume13
Issue number5
DOIs
StatePublished - May 2006
Externally publishedYes

Fingerprint

Subarachnoid Hemorrhage
Angiography
Spinal Puncture
Tomography
Hospital Emergency Service
Aneurysm
Pathology
Intracranial Aneurysm
Multicenter Studies
Computed Tomography Angiography
Catheters
Head

Keywords

  • aneurysm
  • computed tomography
  • CT angiography
  • SAH
  • subarachnoid hemorrhage

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Carstairs, S. D., Tanen, D. A., Duncan, T. D., Nordling, O. B., Wanebo, J. E., Paluska, T. R., ... Riffenburgh, R. H. (2006). Computed Tomographic Angiography for the Evaluation of Aneurysmal Subarachnoid Hemorrhage. Academic Emergency Medicine, 13(5), 486-492. https://doi.org/10.1197/j.aem.2005.12.010

Computed Tomographic Angiography for the Evaluation of Aneurysmal Subarachnoid Hemorrhage. / Carstairs, Shaun D.; Tanen, David A.; Duncan, Timothy D.; Nordling, Olaf B.; Wanebo, John E.; Paluska, Thomas R.; Theodore, Nicholas; Riffenburgh, Robert H.

In: Academic Emergency Medicine, Vol. 13, No. 5, 05.2006, p. 486-492.

Research output: Contribution to journalArticle

Carstairs, SD, Tanen, DA, Duncan, TD, Nordling, OB, Wanebo, JE, Paluska, TR, Theodore, N & Riffenburgh, RH 2006, 'Computed Tomographic Angiography for the Evaluation of Aneurysmal Subarachnoid Hemorrhage', Academic Emergency Medicine, vol. 13, no. 5, pp. 486-492. https://doi.org/10.1197/j.aem.2005.12.010
Carstairs SD, Tanen DA, Duncan TD, Nordling OB, Wanebo JE, Paluska TR et al. Computed Tomographic Angiography for the Evaluation of Aneurysmal Subarachnoid Hemorrhage. Academic Emergency Medicine. 2006 May;13(5):486-492. https://doi.org/10.1197/j.aem.2005.12.010
Carstairs, Shaun D. ; Tanen, David A. ; Duncan, Timothy D. ; Nordling, Olaf B. ; Wanebo, John E. ; Paluska, Thomas R. ; Theodore, Nicholas ; Riffenburgh, Robert H. / Computed Tomographic Angiography for the Evaluation of Aneurysmal Subarachnoid Hemorrhage. In: Academic Emergency Medicine. 2006 ; Vol. 13, No. 5. pp. 486-492.
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abstract = "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.",
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