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[A case with diffuse vasospasm after perimesencephalic nonaneurysmal subarachnoid hemorrhage]
O Hamasaki1, S Sakamoto, T Nakahara
1Department of Neurosurgery, Mazda Hospital, 2-15 Aosaki-Minami, Fuchu-chou, Aki-gun, Hiroshima 735-0017, Japan.
No to Shinkei = Brain and Nerve
|January 5, 2002
Summary
Perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSH) typically has good outcomes. However, this case highlights that severe vasospasm can occur, challenging the traditional understanding of PNSH.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSH) is characterized by bleeding around the midbrain cisterns.
- It is generally associated with excellent prognoses, lacking rebleeding or symptomatic vasospasm.
Observation:
- A 52-year-old woman presented with acute severe headache, diagnosed as PNSH via CT and angiography.
- Serial angiography revealed severe and diffuse vasospasm affecting both anterior and posterior circulations on day 14 post-hemorrhage.
Findings:
- This case demonstrates that severe and diffuse angiographic vasospasm can manifest in PNSH.
- The patient was conservatively managed with normovolemia and remained neurologically asymptomatic.
Implications:
- The presence of severe vasospasm should not preclude a diagnosis of PNSH.
- This finding expands the spectrum of potential complications associated with PNSH, necessitating careful monitoring.