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Case report
peer-reviewed

The Importance of Catheter Angiography in Computed Tomography Angiography-Negative Subarachnoid Hemorrhage



Abstract

Computed tomography angiography (CTA) has become an effective tool in the evaluation of patients with subarachnoid hemorrhage (SAH), but it still has limitations. Up to 15% of non-traumatic SAH cases are negative on CTA. The benefits of catheter angiography in the evaluation of certain cases of CTA-negative SAH have been previously demonstrated. Here, we present the case of a 48-year-old female who presented with headache and right-sided hemiparesis, who later became apneic and required intubation. A computed tomography (CT) scan of the head demonstrated a diffuse SAH. A CTA of the head and neck showed no vascular abnormality. Catheter angiography diagnosed a conical-shaped aneurysm at the left A1-A2 junction of the anterior communicating artery complex measuring 3.5 mm by 1 mm. The aneurysm was successfully treated with a craniotomy and microvascular clipping using a 4.7 mm curved Yasargil miniclip (Aesculap, Tuttlingen, Germany). This case illustrates the importance and benefit of catheter angiography in CTA-negative cases of SAH.



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Case report
peer-reviewed

The Importance of Catheter Angiography in Computed Tomography Angiography-Negative Subarachnoid Hemorrhage


Author Information

Ali S. Haider

Texas A&M College of Medicine

Health Science Center, Scott & White Clinic

Caleb Gottlich

Texas A&M College of Medicine

Anadjeet Khahera

School of Medicine, University of California

Steven Vayalumkal Corresponding Author

School of Medicine, St. George's University

Umair Khan

School of Medicine, St. Georges University

Eliel N. Arrey

Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, TX

UT Houston Medical School, Memorial Hermann

Jacob Campbell

Texas A&M College of Medicine

Richa Thakur

Texas A&M College of Medicine

Sam Finn

HSS Management

Kennith F. Layton

Department of Radiology, Baylor University Medical Center


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: The authors have declared that no conflicts of interest exist.


Case report
peer-reviewed

The Importance of Catheter Angiography in Computed Tomography Angiography-Negative Subarachnoid Hemorrhage


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Case report
peer-reviewed

The Importance of Catheter Angiography in Computed Tomography Angiography-Negative Subarachnoid Hemorrhage

  • Author Information
    Ali S. Haider

    Texas A&M College of Medicine

    Health Science Center, Scott & White Clinic

    Caleb Gottlich

    Texas A&M College of Medicine

    Anadjeet Khahera

    School of Medicine, University of California

    Steven Vayalumkal Corresponding Author

    School of Medicine, St. George's University

    Umair Khan

    School of Medicine, St. Georges University

    Eliel N. Arrey

    Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, TX

    UT Houston Medical School, Memorial Hermann

    Jacob Campbell

    Texas A&M College of Medicine

    Richa Thakur

    Texas A&M College of Medicine

    Sam Finn

    HSS Management

    Kennith F. Layton

    Department of Radiology, Baylor University Medical Center


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements


    Article Information

    Published: May 17, 2017

    DOI

    10.7759/cureus.1254

    Cite this article as:

    Haider A S, Gottlich C, Khahera A, et al. (May 17, 2017) The Importance of Catheter Angiography in Computed Tomography Angiography-Negative Subarachnoid Hemorrhage. Cureus 9(5): e1254. doi:10.7759/cureus.1254

    Publication history

    Received by Cureus: April 30, 2017
    Peer review began: May 08, 2017
    Peer review concluded: May 10, 2017
    Published: May 17, 2017

    Copyright

    © Copyright 2017
    Haider et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Computed tomography angiography (CTA) has become an effective tool in the evaluation of patients with subarachnoid hemorrhage (SAH), but it still has limitations. Up to 15% of non-traumatic SAH cases are negative on CTA. The benefits of catheter angiography in the evaluation of certain cases of CTA-negative SAH have been previously demonstrated. Here, we present the case of a 48-year-old female who presented with headache and right-sided hemiparesis, who later became apneic and required intubation. A computed tomography (CT) scan of the head demonstrated a diffuse SAH. A CTA of the head and neck showed no vascular abnormality. Catheter angiography diagnosed a conical-shaped aneurysm at the left A1-A2 junction of the anterior communicating artery complex measuring 3.5 mm by 1 mm. The aneurysm was successfully treated with a craniotomy and microvascular clipping using a 4.7 mm curved Yasargil miniclip (Aesculap, Tuttlingen, Germany). This case illustrates the importance and benefit of catheter angiography in CTA-negative cases of SAH.



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Ali S. Haider

Texas A&M College of Medicine

Caleb Gottlich, Medical Student

Texas A&M College of Medicine

Anadjeet Khahera

School of Medicine, University of California

Steven Vayalumkal

School of Medicine, St. George's University

For correspondence:
svayalumkal999@gmail.com

Umair Khan, Medical Student

School of Medicine, St. Georges University

Eliel N. Arrey

Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, TX

Jacob Campbell

Texas A&M College of Medicine

Richa Thakur, Medical Student

Texas A&M College of Medicine

Sam Finn

HSS Management

Kennith F. Layton

Department of Radiology, Baylor University Medical Center

Ali S. Haider

Texas A&M College of Medicine

Caleb Gottlich, Medical Student

Texas A&M College of Medicine

Anadjeet Khahera

School of Medicine, University of California

Steven Vayalumkal

School of Medicine, St. George's University

For correspondence:
svayalumkal999@gmail.com

Umair Khan, Medical Student

School of Medicine, St. Georges University

Eliel N. Arrey

Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, TX

Jacob Campbell

Texas A&M College of Medicine

Richa Thakur, Medical Student

Texas A&M College of Medicine

Sam Finn

HSS Management

Kennith F. Layton

Department of Radiology, Baylor University Medical Center