An Analysis of 88 Patients with Diffuse and “Benign” Perimesencephalic Subarachnoid Hemorrhage

Patel, Neal B.; Patel, Akash D; Wilkinson, Jared; Gianaris, Nicholas; Payner, Troy D.; Leipzig, Thomas J.; Ansari, Shaheryar F.; Cohen-Gadol, Aaron

doi:10.1055/s-0034-1368691

Cited by 8 publications

(2 citation statements)

References 42 publications

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“…[ 18 , 19 ] However, patients with PNSAH were associated with an excellent prognosis with an uncomplicated illness course and a low risk of rebleeding, cerebral vasospasm, hydrocephalus, delayed cerebral ischemia, no decrease in quality of life and death. [ 4 , 5 , 7 , 18 – 20 ] But it has been reported that cognitive impairment was common in this cohort. [ 6 ] Several risk factors for PNSAH have been suggested such as younger age, female sex, and smoking.…”

Section: Discussionmentioning

confidence: 87%

“…[ 3 ] In contradistinction to aneurysmal SAH, PNSAH has an excellent prognosis with an uneventful clinical course and a low risk of vasospasm, rebleeding, hydrocephalus, and delayed cerebral ischemia. [ 4 , 5 ] However, many patients with PNSAH complained of functional decline which prevented them from returning to work. [ 6 ] The pathogenesis and mechanisms of the PNSAH are controversial.…”

Section: Introductionmentioning

confidence: 99%

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Perimesencephalic nonaneurysmal subarachnoid hemorrhage caused by transverse sinus thrombosis

Fu¹,

Rao

Zheng³

et al. 2017

Medicine

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Rationale:Perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSAH) is characterized by a pattern of extravasated blood restricted to the perimesencephalic cisterns, normal angiographic findings, and an excellent prognosis with an uneventful course and low risks of complication. The precise etiology of bleeding in patients with PNSAH has not yet been established. The most common hypothesis is that PNSAH is venous in origin. Intracranial venous hypertension has been considered as the pivotal factor in the pathogenesis of PNSAH. The underlying venous pathology such as straight sinus stenosis, jugular vein occlusion may contribute to PNSAH. We describe a patient in whom transverse sinus thrombosis preceded intracranial venous hypertension and PNSAH. These findings supported that the source of the subarachnoid hemorrhage is venous in origin.Patient concerns and diagnoses:A 45-year-old right-handed man was admitted to the hospital with a sudden onset of severe headache associated with nausea, vomiting, and mild photophobia for 6 hours. The patient was fully conscious and totally alert. An emergency brain computed tomography (CT) revealed an acute subarachnoid hemorrhage restricted to the perimesencephalic cisterns. CT angiography revealed no evidence of an intracranial aneurysm or underlying vascular malformation. Digital subtraction angiography of arterial and capillary phases confirmed the CT angiographic findings. Assessment of the venous phase demonstrated right transverse sinus thrombosis. Magnetic resonance imaging confirmed the diagnosis of cerebral venous sinus thrombosis (CVST). Lumbar puncture revealed an opening pressure of 360 mmH2O, suggestive of intracranial venous hypertension. Grave disease was diagnosed by endocrinological investigation.Interventions:Low-molecular-weight heparin, followed by oral warfarin, was initiated immediately as the treatment for cerebral venous sinus thrombosis and PNSAH.Outcomes:The patient discharged without any neurologic defect after 3 weeks of hospital stay. MR venography revealed recanalization of right transverse sinus at the 6-month follow-up. No clinical or neuroimaging evidence of relapse was detected at 12 months follow-up.Lessons:Hyperthyroidism may contribute to the development of CVST. The presence of acute transverse sinus thrombosis, as a cause of PNSAH, provides further support for the hypothesis that the source of PNSAH is venous in origin and intracranial venous hypertension plays a critical role in the pathogenesis of PNSAH.

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Section: Discussionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Perimesencephalic nonaneurysmal subarachnoid hemorrhage caused by transverse sinus thrombosis

Fu¹,

Rao

Zheng³

et al. 2017

Medicine

View full text Add to dashboard Cite

show abstract

Perimesencephalic subarachnoid hemorrhage with a positive angiographic finding: case report and review of the literature

et al. 2016

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The vast majority of perimesencephalic subarachnoid hemorrhage cases are reported as negative-finding etiologies. Recently, high-resolution images allowed us to overcome the previous difficulty of finding the source of bleeding, which underlies the concept of a "negative finding". We discovered a venous etiology, hidden behind the tip of the basilar artery; namely, the lateral pontine vein. Here, we review the literature on perimesencephalic subarachnoid hemorrhage and on venous aneurysm. We highlight this type of aneurysm as a candidate source of perimesencephalic hemorrhage. This case may change our way of dealing with what we have termed a negative finding of subarachnoid hemorrhage.

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Application of LRG mechanism in normal pressure hydrocephalus

Ma,

Wang,

Zhao

et al. 2024

Heliyon

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An Analysis of 88 Patients with Diffuse and “Benign” Perimesencephalic Subarachnoid Hemorrhage

Abstract: Our data demonstrate that although the patients with perimesencephalic SAH fared better than those with diffuse SAH, their outcomes were worse than those of similar patients with PMSAH who have been previously reported in the literature.

Cited by 8 publications

References 42 publications

Perimesencephalic nonaneurysmal subarachnoid hemorrhage caused by transverse sinus thrombosis

Perimesencephalic nonaneurysmal subarachnoid hemorrhage caused by transverse sinus thrombosis

Perimesencephalic subarachnoid hemorrhage with a positive angiographic finding: case report and review of the literature

Application of LRG mechanism in normal pressure hydrocephalus

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