====== Perimesencephalic subarachnoid hemorrhage cerebral angiography ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1rkWqR_Z1ASSsefry9OJdiRlCEqOg6t2wzkzr79pukjQo3xUMu/?limit=15&utm_campaign=pubmed-2&fc=20230830025717}}
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A survey aimed to evaluate the clinical management among neurosurgical departments in Germany. 135 neurosurgical departments in Germany. Indication for a second DSA is set in the majority of centers, whereas after two negative ones, a third DSA is less often indicated (2nd: 66.2%, 72.5%, 86.2%; 3rd: 3.8%, 3.8%, 13.8% minor, moderate, severe). This study confirms the influence of bleeding severity on treatment and follow-up of NASAH patients. Additionally, the existing inconsistency of treatment pathways throughout Germany is highlighted. Therefore, Wolfert et al. suggest to conceive new treatment guidelines including this finding
((Wolfert C, Maurer CJ, Sommer B, Steininger K, Motov S, Bonk MN, Krauss P, Berlis A, Shiban E. Management of perimesencephalic nonaneurysmal subarachnoid hemorrhage: a national survey. Sci Rep. 2023 Aug 7;13(1):12805. doi: 10.1038/s41598-023-39195-2. PMID: 37550334; PMCID: PMC10406943.))
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95% of cases have a normal [[cerebral angiography]] and the source of bleeding is not identified; the cause is thought to be a venous bleed. The other 5% of cases are due to a [[vertebrobasilar aneurysm]] and the prognosis is worse.


Undertaking a DSA after a negative CTA may not add any further diagnostic value in patients with PMSAH and may lead to net harm. This observation needs to be validated in a large-scale prospective multicenter study with complete case ascertainment and robust data on CTA and DSA complications
((Mohan M, Islim A, Dulhanty L, Parry-Jones A, Patel H. CT angiogram negative perimesencephalic subarachnoid hemorrhage: is a subsequent DSA necessary? A systematic review. J Neurointerv Surg. 2019 Dec;11(12):1216-1221. doi: 10.1136/neurintsurg-2019-015051. Epub 2019 Jul 4. PMID: 31273072.)).
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A repeat [[DSA]] is definitely not required in PM-SAH, but it should be done for all cases of nPM-SAH, before labeling them as nonaneurysmal SAH
((Yeole U, Nagesh M, Shukla D, R AH, R PA. The Yield of Repeat Angiography in Angiography-Negative Spontaneous Subarachnoid Hemorrhage. J Neurosci Rural Pract. 2020 Oct;11(4):565-572. doi: 10.1055/s-0040-1714313. Epub 2020 Aug 11. PMID: 33144792; PMCID: PMC7595787.)).