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Perimesencephalic subarachnoid hemorrhage: Etiologies, risk factors, and necessity of the second angiogram
Soner Şahin1, Emre Delen2, Ender Korfali3
1Department of Neurosurgery, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey.
Aim:
In this paper, we aim to present our experience with a series of patients with PMSAH. In addition, the clinical course of perimesencephalic subarachnoid hemorrgade (PMSAH) is discussed with an evaluation of etiologies, risk factors, and the necessity for a second angiogram on follow-up.
Materials And Methods:
The data for this study were obtained retrospectively from patients who were treated at the Uludag University, School of Medicine, Department of Neurosurgery, Division of Neurovascular Surgery's clinic with a diagnosis of PMSAH between January 1980 and March 2002.
Results:
We identified a total of 24 patients, 12 male. The mean age at the time of hemorrhage was 53 ± 12 years. In all patients, the onset was typical with a sudden severe headache. Five of the patients were Hunt-Hess Grade I, 15 were Grade II, and 4 were Grade III. The initial 4-vessel angiography was normal in 23 cases. Twenty-two had a second 4-vessel angiography, and all were normal. We observed acute hydrocephalus in 5 patients (20.8%). We did not observe re-bleeding during the follow-up of our patients.
Conclusion:
Patients with PMSAH have a particularly excellent outcome, and there is no need to evaluate these patients with repeat angiography.
Insights
Patients with perimesencephalic subarachnoid hemorrhage (PMSAH) experience excellent outcomes. Repeat angiography is unnecessary for these patients, simplifying follow-up care and reducing unnecessary procedures.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Neuroradiology
Background:
- Perimesencephalic subarachnoid hemorrhage (PMSAH) is a specific subtype of non-traumatic subarachnoid hemorrhage.
- Understanding its clinical course, etiology, and risk factors is crucial for appropriate patient management.
- The necessity of repeat angiography in PMSAH diagnosis and management remains a topic of discussion.
Purpose of the Study:
- To present clinical experience with perimesencephalic subarachnoid hemorrhage (PMSAH).
- To evaluate the etiologies and risk factors associated with PMSAH.
- To assess the necessity of repeat angiography in the follow-up of PMSAH patients.
Main Methods:
- Retrospective analysis of patients diagnosed with PMSAH between 1980 and 2002.
- Inclusion of patient demographics, clinical presentation, and diagnostic imaging findings.
- Review of follow-up data, including re-bleeding events and need for repeat angiography.
Main Results:
- A total of 24 patients (12 male) with PMSAH were identified, with a mean age of 53 ± 12 years.
- All patients presented with sudden severe headache; initial 4-vessel angiography was normal in 23 cases.
- Repeat angiography in 22 patients also yielded normal results, with no observed re-bleeding during follow-up.
Conclusions:
- Perimesencephalic subarachnoid hemorrhage (PMSAH) is associated with an excellent patient outcome.
- Repeat angiography is not indicated for the follow-up evaluation of PMSAH patients.
- This finding simplifies management protocols and avoids unnecessary invasive procedures.
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