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Vol. 3. Issue 3.
Pages 197-205 (January 1992)
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Vol. 3. Issue 3.
Pages 197-205 (January 1992)
Hemorragia subaracnoidea idiopática. Estudio clínico de una serie de 258 casos
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P.A. Gómez, J.J. Rivas, R.D. Lobato, A. Cabrera, R. Alday, S. Castro, J.M. Ortega, H. Sandoval, E. Lamas
Servicio de Neurocirugía, Hospital «12 de Octubre», Madrid
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Resumen

Se analizan retrospectivamente 258 casos consecutivos de hemorragia subaracnoidea idiopática, tratados durante los años 1974–1991; éstos representan el 34% del total de hemorragias subaracnoideas diagnosticadas en el mismo período. Se discuten los datos clínicos y radiológicos de ésta en entidad y se comparan con los de la hemorrragia subaracnoidea aneurismática, comprobándose una menor incidencia de complicaciones neurológicas (isquemia 8% y resangrado 6%) y una mejor evolución final (90,3% independientes y sólo un 5,4% de mortalidad) que en los pacientes con aneurisma. Asimismo, se analiza la distribución de sangre en las cisternas subaracnoideas, apreciándose una mayor afectación de las cisternas peritruncales (interpeduncular y ambiens). Se desaconseja repetir el estudio angiográfico si éste es completo y de buena calidad, pudiéndose repetir éste si existe resangrado, si el grado clínico inicial es malo, si hubo vasoespasmo en el estudio angiográfico, o si la TC al ingreso muestra una extensa distribución de sangre por cisternas basales.

Palabras clave:
Hemorragia subaracnoidea
angiografia negativa
hallazgos TC
complicaciones
evolución final
Summary

A series of 258 cases of subarachnoid hemorrhage of unknown etiology (SAHUE) is analyzed. These cases represent 34% of the total cases of primary subarachnoid hemorrhage diagnosed during the same period. The clinical and radiological findings in patients with SAHUE are compared with those in patients with ruptured aneurysm. The most important neurological complications i.e., ischemia and rebleeding had a lower incidence in patients with SAHUE (8% and 6% respectively) and the final outcome was more favourable than in patients with ruptured aneurysm (90,3% of the patients recovered and only 5,4% died). The analysis of the location of extravasated blood in patients with SAHUE showed a preferent distribution in the interpeduncular and ambiens cisterns, in contrast to patients with ruptured aneurysms. Concerning misdiagnosis resulting from an overlooked aneurysm at initial angiography, we suggest that cerebral angiography should be repeated when 1) the initial study shows vasospasm, 2) when rebleeding occurs, 3) if the initial clinical grade is bad and, 4) when the initial CT sean shows diffuse subarachnoid bleeding through the basal cisterns.

Key words:
Subarachnoid hemorrhage
negative angiography
CT findings
complications
outcome

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