Yuan Hong1, Yuanjian Fang1, Ting Chen2, Jianmin Zhang3. 1. Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China. 2. Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China. Electronic address: 617716@163.com. 3. Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Brain Research Institute, Zhejiang University, Hangzhou, Zhejiang, China; Collaborative Innovation Center for Brain Science, Zhejiang University, Hangzhou, Zhejiang, China.
Abstract
BACKGROUND: Perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSAH) is a benign form of subarachnoid hemorrhage (SAH) with a favorable prognosis. The risk of recurrent hemorrhage of this benign entity is extremely low. CASE DESCRIPTION: We describe a rare case of recurrent, spontaneous PNSAH in a 56-year-old man. This hypertensive patient suffered a recurrent episode of PNSAH 1 month after its first ictus, suggesting rebleeding can still occur in the setting of PNSAH; however, the risk is much less than that in aneurysmal SAH. No source of the hemorrhage was identified in the imaging examinations, even with the performance of a 6-vessel angiography. CONCLUSIONS: Despite the PNSAH owning benign clinical manifestations and a favorable outcome, this distinct case of recurrent PNSAH demonstrated that the risk of recurrent hemorrhage of PNSAH does exist, although it is rather low. A conservative approach with close follow-up is still warranted for PNSAH patients.
BACKGROUND:Perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSAH) is a benign form of subarachnoid hemorrhage (SAH) with a favorable prognosis. The risk of recurrent hemorrhage of this benign entity is extremely low. CASE DESCRIPTION: We describe a rare case of recurrent, spontaneous PNSAH in a 56-year-old man. This hypertensivepatient suffered a recurrent episode of PNSAH 1 month after its first ictus, suggesting rebleeding can still occur in the setting of PNSAH; however, the risk is much less than that in aneurysmalSAH. No source of the hemorrhage was identified in the imaging examinations, even with the performance of a 6-vessel angiography. CONCLUSIONS: Despite the PNSAH owning benign clinical manifestations and a favorable outcome, this distinct case of recurrent PNSAH demonstrated that the risk of recurrent hemorrhage of PNSAH does exist, although it is rather low. A conservative approach with close follow-up is still warranted for PNSAH patients.
Authors: Peter Marx; Gerhard Hamann; Otto Busse; Thomas Mokrusch; Hendrik Niemann; Hartmut Vatter; Bernhard Widder Journal: Neurol Res Pract Date: 2019-10-23