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Perimesencephalic subarachnoid hemorrhage. Additional perspectives from four cases

W I Schievink1, E F Wijdicks, D G Piepgras

  • 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minn. 55905.

Stroke
|July 1, 1994
PubMed
Summary

Nonaneurysmal perimesencephalic hemorrhage can occur in children and may not originate from arteries. Posterior circulation aneurysms should be suspected in perimesencephalic hemorrhage cases.

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Area of Science:

  • Neurology
  • Neurosurgery
  • Radiology

Background:

  • Perimesencephalic hemorrhage is a specific subtype of subarachnoid hemorrhage.
  • This condition is often associated with intracranial hemorrhage.

Observation:

  • Two patients presented with unusual features of nonaneurysmal perimesencephalic hemorrhage.
  • Two patients had a perimesencephalic hemorrhage pattern due to ruptured posterior circulation aneurysms.
  • A negative exploratory craniotomy in one case suggests non-arterial sources for nonaneurysmal perimesencephalic hemorrhage.

Findings:

  • Nonaneurysmal perimesencephalic hemorrhage can occur in pediatric patients.
  • Aneurysms in the posterior circulation may be the source of perimesencephalic hemorrhage.
  • Missed or unusual aneurysm locations can complicate diagnosis.

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Implications:

  • The clinical spectrum of perimesencephalic subarachnoid hemorrhage is broader than previously recognized.
  • Diagnostic vigilance for posterior circulation aneurysms is crucial in perimesencephalic hemorrhage.
  • Further research into non-arterial sources of hemorrhage is warranted.