Abstract
Between September 1971 and December 1982, 623 patients were admitted for treatment of cerebral aneurysms. Of these patients, there were 10 whose initial panangiography showed negative findings for bleeding.
The aneurysms were subsequently revealed by repeat angiography in 8 patients and by autopsy in 2. The location of the aneurysm was the anterior communicating artery in 5 patients, the middle cerebral in 3, and the internal carotid in 2. The size of the aneurysm, when detected, was small: the average was 3.0 mm in length and 2.5 mm in diameter. The possible causes of diagnostic error at the initial angiography were thought to be: severe vasospasms in 1 patient, inadequate projections in 4, films of poor quality in 2, ruptured aneurysm overlooked in patients with multiple aneurysms in 2, and no distinct evidence of aneurysm even in retrospect in 1. The clinical grade after Hunt and Hess on admission was Grade I in 2 patients, Grade III in 4, Grade IV in 3, and Grade V in 1. The clinical outcome was excellent in 3 patients, good in 2, poor in 1, and dead in 4. The patients who became poor had had diffuse, severe vasospasms and demonstrated cerebral infarction in the regions supplied by the involved arteries. One patient had experienced a second bleeding before the correct diagnosis was achieved.
