Article Text

Download PDFPDF
P-015 A New Grading System for Predicting Angiogram Negative Subarachnoid Haemorrhage
  1. I Darie,
  2. T Rayan,
  3. S Amin-Hanjani,
  4. X Du,
  5. V Aletich,
  6. F Charbel,
  7. A Alaraj
  1. Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA


Introduction Angiogram negative subarachnoid haemorrhage (AN-SAH) account for about 15% of all non-traumatic SAH cases. In this paper we developed a new CT based grading system for distinguishing AN-SAH vs. aneurysmal SAH (a-SAH).

Methods A new CT grading classification was developed based on the Hijdra system. Patterns of SAH in 13 cisterns were scored between 0–2 depending on the amount of haemorrhage (0 = No blood; 1 = partial; 2 = full). The patterns of blood in the interpeduncular, pre-pontine and pre-medullary cisterns were scored in one category: P score (range 0–6); the total amount of blood in the entire 13 cisterns was scored under T score (range 0–26). Initial CT scans from 148 consecutive AN-SAH and 180 a-SAH patients were reviewed and scored by two independent blinded neurosurgeons. Patients with pure cortical or traumatic SAH or those with CT scan performed >72 h after the SAH ictus were excluded. All performed angiograms (1st, 2ndand 3rdlook, if performed) were reviewed for presence of aneurysms.

Results In patients with CT scan scores between P0-1;T > 9, the performed angiograms were positive in 92% (23 a-SAH vs. 2 AN-SAH), whereas in those scoring P0-1;T < 10 angiography revealed a much higher incidence of positive findings (52% a-SAH vs. 48% AN-SAH, p = 0.33). For Px; T < x+8 (x between 2–6), the angiograms were negative in 94.6% of cases (3 a-SAH vs. 53 AN-SAH), and in a subset of this category (P4-6; T < 14) the angiograms were negative in 100% of cases (n = 34). For patients scoring (P0-1; T < 10) and Px; T > x+7(x between 2–6) the scores were not predictive of angiogram results (65% a-SAH vs. AN-SAH 35%).

Conclusion The new CT scan scoring provides an estimate for the likelihood of a negative angiogram in patients with SAH. Significant blood in the pre-brainstem cisterns with minimal or modest blood in the remaining cisterns best predicts absence of aneurysm or vascular lesion on initial and follow-up angiography.

Disclosures I. Darie: None. T. Rayan: None. S. Amin-Hanjani: None. X. Du: None. V. Aletich: None. F. Charbel: None. A. Alaraj: None.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.