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Pretruncal nonaneurysmal subarachnoid hemorrhage

E F Wijdicks1, W I Schievink, G M Miller

  • 1Department of Neurology, Mayo Clinic Rochester, Minnesota 55905, USA.

Mayo Clinic Proceedings
|August 14, 1998
PubMed
Summary
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Patients with pretruncal nonaneurysmal subarachnoid hemorrhage typically present with sudden headache and have an excellent outcome. Careful neuroimaging and angiography are crucial to exclude posterior circulation aneurysms.

Area of Science:

  • Neurology
  • Neurosurgery
  • Radiology

Background:

  • Subarachnoid hemorrhage (SAH) can result from ruptured aneurysms or other causes.
  • Pretruncal nonaneurysmal subarachnoid hemorrhage is a specific subtype with distinct characteristics.
  • Understanding its diagnostic evaluation and clinical course is essential for patient management.

Purpose of the Study:

  • To review the diagnostic evaluation of patients with pretruncal nonaneurysmal subarachnoid hemorrhage.
  • To describe the clinical course and outcomes of these patients.
  • To differentiate from aneurysmal SAH.

Main Methods:

  • Retrospective review of consecutive patients with pretruncal nonaneurysmal SAH at Mayo Clinic Rochester over 6 years.
  • Analysis of clinical manifestations, neuroimaging findings, and management strategies.

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  • Inclusion of four-vessel cerebral angiography for diagnosis and follow-up.

    • Main Results:

    • 24 patients (15 male, 9 female; age 3-72) presented with sudden explosive headache.
    • Hemorrhage was centered prepontine, extending into basal cisterns.
    • Neuroimaging identified hemorrhage, with some initially missed on CT.
    • Cerebral vasospasm occurred in some patients post-angiography; no rebleeding was observed.

    Conclusions:

    • Pretruncal nonaneurysmal SAH has an excellent outcome, contrasting with aneurysmal SAH.
    • Ruptured posterior circulation aneurysms can mimic this condition.
    • A technically satisfactory cerebral angiogram is vital to exclude aneurysmal causes.