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Original research
Yield of diagnostic imaging in atraumatic convexity subarachnoid hemorrhage
  1. Katarina Dakay1,
  2. Ali Mahta1,2,
  3. Shyam Rao1,2,
  4. Michael E Reznik1,2,
  5. Linda C Wendell1,2,
  6. Bradford B Thompson1,2,
  7. N Stevenson Potter1,2,
  8. Ali Saad1,
  9. Chirag D Gandhi3,
  10. Justin Santarelli3,
  11. Fawaz Al-Mufti3,
  12. Brian MacGrory1,
  13. Tina Burton1,
  14. Mahesh V Jayaraman1,2,4,
  15. Ryan A McTaggart1,2,4,
  16. Karen Furie1,
  17. Shadi Yaghi1,5,
  18. Shawna Cutting1
  1. 1 Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
  2. 2 Department of Neurosurgery, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
  3. 3 Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
  4. 4 Department of Diagnostic Imaging, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
  5. 5 Department of Neurology, NYU Langone Health, New York, New York, USA
  1. Correspondence to Dr Katarina Dakay, Department of Neurology, Brown University Warren Alpert Medical School, Providence, RI 02903, USA; kdakay{at}


Introduction Atraumatic convexity subarachnoid hemorrhage is a subtype of spontaneous subarachnoid hemorrhage that often presents a diagnostic challenge. Common etiologies include cerebral amyloid angiopathy, vasculopathies, and coagulopathy; however, aneurysm is rare. Given the broad differential of causes of convexity subarachnoid hemorrhage, we assessed the diagnostic yield of common tests and propose a testing strategy.

Methods We performed a single-center retrospective study on consecutive patients with atraumatic convexity subarachnoid hemorrhage over a 2-year period. We obtained and reviewed each patient’s imaging and characterized the frequency with which each test ultimately diagnosed the cause. Additionally, we discuss clinical features of patients with convexity subarachnoid hemorrhage with respect to the mechanism of hemorrhage.

Results We identified 70 patients over the study period (mean (SD) age 64.70 (16.9) years, 35.7% men), of whom 58 patients (82%) had a brain MRI, 57 (81%) had non-invasive vessel imaging, and 27 (38.5%) underwent catheter-based angiography. Diagnoses were made using only non-invasive imaging modalities in 40 patients (57%), while catheter-based angiography confirmed the diagnosis in nine patients (13%). Further clinical history and laboratory testing yielded a diagnosis in an additional 17 patients (24%), while the cause remained unknown in four patients (6%).

Conclusion The etiology of convexity subarachnoid hemorrhage may be diagnosed in most cases via non-invasive imaging and a thorough clinical history. However, catheter angiography should be strongly considered when non-invasive imaging fails to reveal the diagnosis or to better characterize a vascular malformation. Larger prospective studies are needed to validate this algorithm.

  • subarachnoid
  • MRI
  • magnetic resonance angiography
  • hemorrhage
  • angiography

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  • Contributors KD: study concept, literature review, data collection, manuscript preparation and revision. SY, SC: study concept, critical review, manuscript revision. All other authors provided substantial critical review and revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval The study was approved by the local Institutional Review Board at the participating center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data are presented in this paper.

  • Presented at AANS/CNS Joint Section Meeting (E-poster), February 4-5 2019, Honolulu, HI.

  • Patient consent for publication Not required.