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[Spontaneous perimesencephalic subarachnoid hemorrhage (PMH). A disease category with good prognosis?]
E M Meisenzahl1, S Gottschalk, C Lechner
1Abteilung für Neuroradiologie, Universitätsklinikum Charité, Humboldt-Universität Berlin.
Abstract:
Perimesencephalic subarachnoidal haemorrhage (PMH) is characterized by a typical blood distribution pattern in the basal cysterns in the CAT, missing evidence of an aneurysm in the panangiogram, a mild clinical course and a very positive prognosis. Between 1990 and 1995, 108 inpatients with non-traumatic subarachnoidal haemorrhage were treated in our clinic. Within this group 14 patients (13%) were identified retrospectively with a perimesencephalic haemorrhage distribution pattern in the CAT and a negative panangiogram. These patients experienced a mild clinical course with excellent outcome without rebleeding during the observation period of 2 to 50 months. All patients were fully able to work, and only two patients complained of frequent headaches. The mild clinical course, the negative panangiogram as well as the extremely positive outcome confirm the hypothesis of of a benign subgroup of non-traumatic subarachnoidal haemorrhages.
Insights
Perimesencephalic subarachnoidal hemorrhage (PMH) is a distinct subtype of non-traumatic subarachnoid hemorrhage. Patients with PMH exhibit a benign clinical course and excellent prognosis, with no rebleeding observed.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Perimesencephalic subarachnoidal hemorrhage (PMH) presents a characteristic pattern of blood distribution on CT scans.
- It is typically associated with negative findings on panangiography, suggesting no identifiable aneurysm.
Purpose of the Study:
- To retrospectively identify and characterize patients with perimesencephalic subarachnoidal hemorrhage (PMH) within a larger cohort of non-traumatic subarachnoid hemorrhage cases.
- To evaluate the clinical course and long-term outcomes of patients diagnosed with PMH.
Main Methods:
- Retrospective analysis of 108 inpatients with non-traumatic subarachnoid hemorrhage treated between 1990 and 1995.
- Identification of 14 patients (13%) with PMH based on CT blood distribution and negative panangiograms.
Main Results:
- Patients with PMH experienced a mild clinical course.
- Excellent outcomes were observed, with no rebleeding during a 2- to 50-month follow-up period.
- All patients returned to full work capacity, with only two reporting headaches.
Conclusions:
- The findings support the hypothesis that PMH represents a benign subgroup of non-traumatic subarachnoid hemorrhages.
- PMH is characterized by a favorable prognosis and a mild clinical presentation.
- The typical CT blood pattern and negative angiogram are key diagnostic features.