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Case 2 - Non-aneurysmal perimesencephalic subarachnoid hemorrhage

from Neuroradiology: extra–axial and vascular

Published online by Cambridge University Press:  05 March 2013

By
Robert B. Carr
Edited by
Martin L. Gunn
Martin L. Gunn
Affiliation:
University of Washington School of Medicine
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Summary

Imaging description

Most cases of non-traumatic subarachnoid hemorrhage (SAH) are caused by aneurysm rupture. However, approximately 15% of patients will have no identifiable cause on CT angiography (CTA). In these patients, it is important to assess the pattern of SAH.

A subset of patients with CTA-negative SAH will have a pattern known as non-aneurysmal perimesencephalic subarachnoid hemorrhage (NAPH) (Figure 2.1). Criteria have been established for this, and include the following [1, 2]:

  • Subarachnoid hemorrhage within the perimesencephalic cisterns, centered anterior to the midbrain.

  • Possible extension into the posterior aspect of the anterior interhemispheric fissure, but not completely filling the anterior interhemispheric fissure.

  • Possible extension into the medial aspects of the Sylvian fissures, but no extension laterally within the fissures (Figure 2.2).

  • Possible small amounts of layering intraventricular hemorrhage sedimentation, but no frank intraventricular hemorrhage.

  • No intraparenchymal hemorrhage.

Type
Chapter
Information
Pearls and Pitfalls in Emergency Radiology
Variants and Other Difficult Diagnoses
 , pp. 5 - 7
Publisher: Cambridge University Press
Print publication year: 2013

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References

Rinkel, GJ, Wijdicks, EF, Vermeulen, M, et al. Nonaneurysmal perimesencephalic subarachnoid hemorrhage: CT and MR patterns that differ from aneurysmal rupture. AJNR Am J Neuroradiol. 1991;12(5):829–34.Google Scholar
Velthuis, BK, Rinkel, GJ, Ramos, LM, Witkamp, TD, van Leeuwen, MS. Perimesencephalic hemorrhage. Exclusion of vertebrobasilar aneurysms with CT angiography. Stroke. 1999;30(5):1103–9.CrossRefGoogle ScholarPubMed
Wijdicks, EF, Schievink, WI, Miller, GM. Pretruncal nonaneurysmal subarachnoid hemorrhage. Mayo Clin Proc. 1998;73(8):745–52.CrossRefGoogle ScholarPubMed
Schwartz, TH, Mayer, SA. Quadrigeminal variant of perimesencephalic nonaneurysmal subarachnoid hemorrhage. Neurosurgery. 2000;46(3):584–8.CrossRefGoogle ScholarPubMed
Hui, FK, Tumialan, LM, Tanaka, T, Cawley, CM, Zhang, YJ. Clinical differences between angiographically negative, diffuse subarachnoid hemorrhage and perimesencephalic subarachnoid hemorrhage. Neurocrit Care. 2009;11(1):64–70.CrossRefGoogle ScholarPubMed
Agid, R, Andersson, T, Almqvist, H, et al. Negative CT angiography findings in patients with spontaneous subarachnoid hemorrhage: When is digital subtraction angiography still needed?AJNR Am J Neuroradiol. 2010;31(4):696–705.CrossRefGoogle ScholarPubMed
Brinjikji, W, Kallmes, DF, White, JB, et al. Inter- and intraobserver agreement in CT characterization of nonaneurysmal perimesencephalic subarachnoid hemorrhage. AJNR Am J Neuroradiol. 2010;31(6):1103–5.CrossRefGoogle ScholarPubMed

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