The analysis of diagnostic value about clinical, laboratory, CT, MRA, DSA in primary subarachnoid hemorrhage

Objective: To investigate the value of various diagnostic methods used in subarachnoid hemorrhage (SAH) for providing the best choice of method at different periods and for different etiology. Methods: The clinical information and results of lumbar puncture, CT, MRA, DSA were analyzed retrospectively in 122 patients suffering from SAH at different periods in order to investigate the sensitivity of positive findings and analyze the cause of negative findings. Results: Acute headache, vomit, meningeal irritation sign, the change of eyeground were the useful early clinical manifestation. The positive rate of lumbar puncture was 100% and the positive rate of CT was 92% within 72 hours after onset. The positive findings of MRI, MRA were 45.55% in etiological diagnosis, while those of DSA were 70.83% (including 28 cases of aneurysm, 30 of arteriovenous malformation AVM, 5 of dural arteriovenous fistula, 2 of vasculitis, 1 of lateral sinus thrombus). MRI detected vascular malformation of spinal cord in 2 cases. Conclusion: Specific symptom and lumbar puncture are the methods of choice for confirmation diagnosis in patients suffering from SAH within the acute period. Negative result in CT can't rule out SAH. DSA is better than MRA in etiological diagnosis. The actual result etiology could be revealed by MR or spinal cord angiography when all results of CT, MRA , and DSA are normal. (authors)