INTRODUCTION 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. METHODS 140 patients suffering from AN-SAH treated at our institution from 2012 to 2022 were included in this retrospective cohort study. RESULTS 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 MRI identified a spinal bleeding source in 4 patients (2.86%). These patients presented with local spine pain or neurological deficits (RR 3.9706 [95%-CI: 0.7272-21.6792]; p<0.001) and were younger (mean difference 14.85 years [95%-CI: 0.85-28.85; p=0.038]) compared to patients without a spinal bleeding source. CONCLUSIONS 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.

中文翻译：

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非创伤性血管造影阴性蛛网膜下腔出血中脊髓出血来源的频率和特征。

引言 血管造影阴性蛛网膜下腔出血 (AN-SAH) 占自发性 SAH 的 5-15%。本研究旨在分析AN-SAH患者脊髓出血来源的频率和特征。方法 这项回顾性队列研究纳入了 2012 年至 2022 年在我们机构接受治疗的 140 名 AN-SAH 患者。结果 52.1%被诊断为中脑周围SAH，35.0%被诊断为非中脑周围SAH，12.9%被诊断为CT阴性SAH（腰椎穿刺诊断）。额外的 MRI 确定了 4 名患者 (2.86%) 的脊髓出血源。这些患者出现局部脊柱疼痛或神经功能缺损（RR 3.9706 [95%-CI: 0.7272-21.6792]；p<0.001）并且年龄较小（平均差异 14.85 岁 [95%-CI: 0.85-28.85；p=0.038] ）与没有脊髓出血源的患者相比。结论 脊柱病理引起的 AN-SAH 很少见。这项研究表明，AN-SAH 应考虑颅颈和全脊髓 MRI，特别是对于出现背痛或神经功能缺损的年轻 AN-SAH 患者。