A minor perimesencephalic subarachnoid hemorrhage on CT changes

Yeting Zhou, Daoming Tong

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DOI: 10.4236/wjns.2011.12004                

Abstract

Despite the increasing number of reports of patients with perimesencephalic subarachnoid hemorrhage (PMSAH), a minor or atypical PMSAH on CT changes has not been reported. We present the first described case of a minor subarachnoid hemorrhage located in the right perimesencephalic cistern on CT 4 h after headache onset. Twenty-six hours after headache on-set, another CT of the head showed that blood dis-persion. On the third day in hospital, examination of cerebrospinal fluid revealed xanthochromia. Minor PMSAH is rare type of SAH, and can been missed if there is a delay in CT imaging of the head. Any pa-tient with a suspected minor PMSAH or equivocal results on CT should undergo routine lumbar punc-ture.

Keywords

Headache; Perimesencephalic Subarachnoid Hemorrhage; CT Imaging; Lumbar Puncture; Angiography

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Rinkel, G.J.E., Wijdicks, E.F.M., Hasan, D., et al. (1991) Outcome in patients with subarachnoid haemorrhage and negative angiography according to pattern of haemorrhage on computed tomography. Lancet, 338, 964-968. doi:10.1016/0140-6736(91)91836-J
[2]	Schwartz, T.H. and Solomon, R.A. (1996) Perimesencephalic nonaneurysmal subarachnoid hemorrhage: Review of the literature. Neurosurgery, 39, 433-440.
[3]	Van Gijn, J., Van Dongen, K.J., Vermeulen, M., et al. (1985) Perimesencephalic hemorrhage: A nonaneurysmal and benign form of subarachnoid hemorrhage. Neurology, 35, 493-497.
[4]	Hui, F.K., Tumialán, L.M., Tanaka, T., et al. (2009) Clinical differences between angiographically negative, diffuse subarachnoid hemorrhage and perimesencephalic subarachnoid hemorrhage. Neurocrit Care, 11, 64-70. doi:10.1007/s12028-009-9203-2
[5]	Flaherty, M.L., Haverbusch, M., Kissela, B., et al. (2005) Perimesencephalic subarachnoid hemorrhage: Incidence, risk factors,and outcoma. Journal of Stroke Cerebrovascular Diseases, 14, 267-71. doi:10.1016/j.jstrokecerebrovasdis.2005.07.004
[6]	Van der Wee, N., Rinkel, G.J.E., Hasan, D., et al. (1995) Detection of subarachnoid haemorrhage on early CT: Is lumbar puncture still needed after a negative scan? Journal of Neurology, Neurosurgery & Psychiatry, 58, 357- 359. doi:10.1136/jnnp.58.3.357
[7]	Richard, L.B, William, R.M, Natalie, S., Gelareh, Z.G., Shanna, F. and Larry, J.B. (2008) Sensitivity of noncontrast cranial computed tomography for the emergency department diagnosis of subarachnoid hemorrhage. Annals of Emergency Medicine, 51, 697-703. doi:10.1016/j.annemergmed.2007.10.007
[8]	Tong, D.M. and Chou, Y.T. (2010) Predictors of the subarachnoid hemorrhage of a negative CT scan. Stroke, 41, e566-e567. doi:10.1161/STROKEAHA.109.574038
[9]	Suarez, J.I., Tarr, R.W. and Selman, W.R. (2006) Aneurysmal subarachnoid hemorrhage. New England Journal of Medicine, 354, 387-396. doi:10.1056/NEJMra052732
[10]	Schievink, W.I., Wijdicks, E.F.M., Piepgras, D.G., et al. (1994) Perimesencephalic subarachnoid hemorrhage: Additional perspectives from four cases. Stroke, 25, 1507-1511. doi:10.1161/01.STR.25.7.1507
[11]	Van Der Schaaf, I.C., Velthuis, B.K., Gouw, A., et al. (2004) Venous drainage in perimesencephalic hemorrhage. Stroke, 35, 1614-1618. doi:10.1161/01.STR.0000131657.08655.ce
[12]	Velthuis, B.K., Rinkel, G.J., Ramos, L.M., et al. (1999) Perimesencephalic hemorrhage: Exclusion of vertebrobasilar aneurysms with CT angiography. Stroke, 30, 1103-1109. doi:10.1161/01.STR.30.5.1103
[13]	Cloft, H.J., Joseph, G.J. and Dion, J.E. (1999) Risk of cerebral angiography in patients with subarachnoid hemorrhage, cerebral aneurysm, and arteriovenous malformation: A meta-analysis. Stroke, 30, 317-320. doi:10.1161/01.STR.30.2.317
[14]	Ruigrok, Y.M., Rinkel, G.J., Buskens, E., et al. (2000) Perimesencephalic hemorrhage and CT angiography: A decision analysis. Stroke, 31, 2976-2983. doi:10.1161/01.STR.31.12.2976