Frequency and Characteristics of Spinal Bleeding Sources in Nontraumatic Angiogram-Negative Subarachnoid Hemorrhage

Abstract

<b><i>Introduction:</i></b> Angiogram-negative subarachnoid hemorrhage (AN-SAH) accounts for 5–15% of spontaneous SAH. This study aims to analyze the frequency and characteristics of spinal bleeding sources in patients with AN-SAH. <b><i>Methods:</i></b> 140 patients suffering from AN-SAH treated at our institution from 2012 to 2022 were included in this retrospective cohort study. <b><i>Results:</i></b> 52.1% were diagnosed with perimesencephalic SAH, 35.0% with non-perimesencephalic, SAH and 12.9% with CT-negative SAH (diagnosed by lumbar puncture). Additional magnetic resonance imaging (MRI) identified a spinal bleeding source in 4 patients (2.86%). These patients presented with local spine pain or neurological deficits (relative risk: 3.9706 [95% confidence interval [CI]: 0.7272–21.6792]; <i>p</i> &lt; 0.001) and were younger (mean difference 14.85 years [95% CI: 0.85–28.85; <i>p</i> = 0.038]) compared to patients without a spinal bleeding source. <b><i>Conclusions:</i></b> AN-SAH caused by spinal pathology is rare. This study indicates that craniocervical and holospinal MRI should be considered in AN-SAH, especially for young patients with AN-SAH who present with back pain or neurological deficits.