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Hemorrhagic Stroke ll: Pathophysiology01:29

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A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
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Related Experiment Video

Updated: Jun 4, 2026

Endovascular Perforation Model for Subarachnoid Hemorrhage Combined with Magnetic Resonance Imaging (MRI)
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Published on: December 16, 2021

Perimesencephalic subarachnoid hemorrhage: when to stop imaging?

Juan Pablo Cruz1, Dipanka Sarma, Lyne Noel de Tilly

  • 1Department of Medical Imaging, University of Toronto, 150 College Street, Toronto, Ontario, Canada.

Emergency Radiology
|March 2, 2011
PubMed
Summary

Computed tomography angiography (CTA) effectively rules out aneurysms in perimesencephalic subarachnoid hemorrhage (PSAH) cases. Digital subtraction angiography (DSA) and follow-up imaging offer no additional diagnostic value after a negative CTA.

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Area of Science:

  • Neurology
  • Radiology
  • Neurosurgery

Background:

  • Perimesencephalic subarachnoid hemorrhage (PSAH) is a subtype of non-traumatic subarachnoid hemorrhage.
  • Identifying the source of bleeding, typically an aneurysm, is crucial for patient management.
  • Computed tomography angiography (CTA) is often the initial imaging modality.

Purpose of the Study:

  • To assess the diagnostic yield of digital subtraction angiography (DSA) and follow-up imaging in patients with PSAH and negative CTA.
  • To determine if DSA or further imaging is necessary when CTA does not reveal an aneurysm.

Main Methods:

  • Retrospective analysis of non-traumatic subarachnoid hemorrhage (SAH) patients who underwent DSA.
  • Selection criteria included PSAH pattern on CT within 72 hours and negative CTA.
  • Comparison of CTA findings with DSA and follow-up imaging results.

Main Results:

  • Forty-nine patients with PSAH and negative CTA were analyzed.
  • Only one patient (2.4%) had a false-negative CTA, with a small aneurysm deemed unlikely to be the source.
  • Follow-up imaging did not reveal any bleeding sources.

Conclusions:

  • CTA is a reliable tool for excluding aneurysms in patients with PSAH.
  • DSA and repeat follow-up imaging provide limited additional diagnostic yield after a negative CTA in this patient group.