Skip to main content
SpringerLink
Log in

Perimesencephalic Subarachnoid Hemorrhage: Risk Factors, Clinical Presentations, and Outcome

  • Conference paper
Book cover Early Brain Injury or Cerebral Vasospasm

Part of the book series: Acta Neurochirurgica Supplements ((NEUROCHIRURGICA,volume 110/1))

Abstract

Background: Perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSH) appears to have an origin and natural history distinct from aneurysm rupture. However, the risk factors and complications of this pattern are still in debate. We performed a study with goals of comparing PNSH risk factors and clinical presentations with other sorts of spontaneous subarachnoid hemorrhages (SAH) and exhibit the PNSH outcome and prognosis.

Methods: Retrospective review of patients who experienced SAH between May 2006 and July 2008 in the First Affiliated Hospital of Chongqing Medical University was undertaken. Patients were categorized as perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSH), nonperimesencephalic nonaneurysmal subarachnoid hemorrhage (NPNSH), aneurismal subarachnoid hemorrhage (ASH), and uncertain SAH of which the patterns were not clear. The possible risk factors and clinical presentations within the three groups were used to proceed for statistical analysis.

Results: A total of 159 residents were identified. Among of them, 12 patients had the perimesencephalic pattern. Patients with PNSH showed less likelihood with the female (P=0.029), alcohol consumption (P=0.033), hypertensive (P=0.005), diabetes (P=0.013) or hyperlipidemia (P=0.034) when compared with aneurismal SAH. The clinical presentations of this pattern showed less conscious disturbance (P=0.004), vomiting (P=0.005), or poor Hunt & Hess Grade (P=0.003). There was one death among PNSH patients during 12months mean follow-up.

Conclusions: Patients with PNSH present better clinical course than other forms of SAH, which could assist the diagnosis of this pattern. The moderate clinical course may suggest clinician apt to exclude aneurysm rupture. However, similar presents in remaining nonaneurysmal subarachnoid hemorrhage might suggest benign entities in other forms of nonaneurysmal subarachnoid hemorrhage.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Rinkel GJ, Wijdicks EF, Vermeulen M, Ramos LM, Tanghe HL, Hasan D, et al. Nonaneurysmal perimesencephalic subarachnoid hemorrhage: CT and MR patterns that differ from aneurysmal rupture. AJNR Am J Neuroradiol. 1991;12:829–34.

    PubMed  CAS  Google Scholar 

  2. Rinkel GJ, Wijdicks EF, Vermeulen M, Hageman LM, Tans JT, van Gijn J. Outcome in perimesencephalic (nonaneurysmal) subarachnoid hemorrhage: a follow-up study in 37 patients. Neurology 1990;40:1130–2.

    Article  PubMed  CAS  Google Scholar 

  3. van Gijn J, Rinkel GJ. Subarachnoid hemorrhage: diagnosis, causes and management. Brain 2001;124(Pt 2):249–78.

    Article  PubMed  CAS  Google Scholar 

  4. Greebe P, Rinkel GJ. Life expectancy after perimesencephalic subarachnoid hemorrhage. Stroke 2007;38(4):1222–4.

    Article  PubMed  Google Scholar 

  5. Ildan F, Tuna M, Erman T, Gocer AI, Cetinalp E. Prognosis and prognostic factors in nonaneurysmal perimesencephalic hemorrhage: a follow-up study in 29 patients. Surg Neurol. 2002;57(3):160–5.

    Article  PubMed  Google Scholar 

  6. Kershenovich A, Rappaport ZH, Maimon S. Brain computed tomography angiographic scans as the sole diagnostic examination for excluding aneurysms in patients with perimesencephalic subarachnoid hemorrhage. Neurosurgery 2006;59(4):798–801.

    Article  PubMed  Google Scholar 

  7. Schwartz TH, Solomon RA. Perimesencephalic nonaneurysmal subarachnoid hemorrhage: review of the literature. Neurosurgery 1996;39:433–40.

    PubMed  CAS  Google Scholar 

  8. Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysm. J Neurosurg. 1968;28:14–20.

    Article  PubMed  CAS  Google Scholar 

  9. Jennett B, Bond M. Assessment of outcome after severe brain damage: a practical scale. Lancet 1975;1:480–4.

    Article  PubMed  CAS  Google Scholar 

  10. de Haan R, Aaronson A, Limburg M, Hewer RL, van Crevel H. Measuring quality of life in stroke. Stroke 1993;24:320–7.

    Article  PubMed  CAS  Google Scholar 

  11. van Gijn J, van Dongen KJ, Vermeulen M, Hijdra A. Perimesencephalic hemorrhage: a nonaneurysmal and benign form of subarachnoid hemorrhage. Neurology 1985;35:493–7.

    Article  PubMed  CAS  Google Scholar 

  12. Jafar JJ, Weiner HL. Surgery for angiographically occult cerebral aneurysms. J Neurosurg. 1993;79:674–9.

    Article  PubMed  CAS  Google Scholar 

  13. Canhao P, Falcao F, Pinho e Melo T, Ferro H, Ferro J. Vascular risk factors for perimesencephalic nonaneurysmal subarachnoid hemorrhage. J Neurol. 1999;246(6):492–6.

    Article  PubMed  CAS  Google Scholar 

  14. Maarten G. Lansberg. Concurrent presentation of perimesencephalic subarachnoid hemorrhage and ischemic stroke. J Stroke Cerebrovasc Dis. 2008;17:248–50.

    Article  PubMed  Google Scholar 

  15. Rinkel GJE, Wijdicks EFM, Hasan D, Kienstra GE, Franke CL, Hageman LM, et al. Outcome in patients 295 with subarachnoid hemorrhage and negative angiography according to pattern of hemorrhage on computed tomography. Lancet 1991;338:964–8.

    Article  PubMed  CAS  Google Scholar 

  16. Van der Schaaf IC, Velthuis BK, Gouw A, Rinkel GJ. Venous drainage in perimesencephalic hemorrhage. Stroke 2004;35:1614–8.

    Article  PubMed  Google Scholar 

  17. Shad A, Rourke TJ, Hamidian Jahromi A, Green AL. Straight sinus stenosis as a proposed cause of perimesencephalic non-aneurysmal haemorrhage. J Clin Neurosci. 2008;15:839–41.

    Article  PubMed  Google Scholar 

  18. Yamakawa H, Ohe N, Yano H, Yoshimura S, Iwama T. Venous drainage patterns in perimesencephalic nonaneurysmal subarachnoid hemorrhage. Clin Neurol Neurosurg. 2008;110:587–91.

    Article  PubMed  Google Scholar 

  19. Herrmann LL, Zabramski JM. Nonaneurysmal subarachnoid hemorrhage: a review of clinical course and outcome in two hemorrhage patterns. J Neurosci Nurs. 2007;39:135–42.

    Article  PubMed  Google Scholar 

  20. Ronkainen A, Niskanen M, Rinne J, Koivisto T, Hernesniemi J, Vapalahti M. Evidence for excess long-term mortality after treated subarachnoid hemorrhage. Stroke 2001;32:2850–3.

    Article  PubMed  CAS  Google Scholar 

  21. Greebe P, Rinkel GJ. Life expectancy after perimesencephalic subarachnoid hemorrhage. Stroke 2007;38:1222–24.

    Article  PubMed  Google Scholar 

  22. Kang DH, Park J, Lee SH, Park SH, Kim YS, Hamm IS. Does non-perimesencephalic type 315 non-aneurysmal subarachnoid hemorrhage have a benign prognosis? J Clin Neurosci. 2009;16:904–8.

    Article  PubMed  Google Scholar 

  23. Gupta SK, Gupta R, Khosla VK, Mohindra S, Chhabra R, Khandelwal N, et al. Nonaneurysmal nonperimesencephalic subarachnoid hemorrhage: is it a benign entity? Surg Neurol. 2009;71:566–72.

    Article  PubMed  Google Scholar 

  24. Dammert S, Krings T, Moller-Hartmann W, Ueffing E, Hans FJ, Willmes K, et al. Detection of intracranial aneurysms with multislice CT: comparison with conventional angiography. Neuroradiology 2004;46:427–34.

    Article  PubMed  CAS  Google Scholar 

  25. Karamessini MT, Kagadis GC, Petsas T, Karnabatidis D, Konstantinou D, Sakellaropoulos GC, et al. CT angiography with three dimensional techniques for the early diagnosis of intracranial aneurysm: comparison with intra-arterial DSA and the surgical findings. Eur J Radiol. 2004;49:212–23.

    Article  PubMed  Google Scholar 

  26. Ruigrok YM, Rinkel GJ, Buskens E, Velthuis BK, van Gijn J. Perimesencephalic hemorrhage and CT angiography: a decision analysis. Stroke 2000;31:2976–83.

    Article  PubMed  CAS  Google Scholar 

  27. Amir K, Zvi HR, Maimon S. Brain computed tomography angiographic scans as the sole diagnostic examination for excluding aneurysms in patients with perimesencephalic subarachnoid hemorrhage. Neurosurgery 2006;59:798–802.

    Article  Google Scholar 

  28. Hashimoto H, Iida J, Hironaka Y, Okada M, Sakaki T. Use of spiral computerized tomography angiography in patients with subarachnoid hemorrhage in whom subtraction angiography did not reveal cerebral aneurysms. J Neurosurg. 2000;92:278–83.

    Article  PubMed  CAS  Google Scholar 

  29. Huttner HB, Hartmann M, Kohrmann M, Neher M, Stippich C, Hahnel S, et al. Repeated digital substraction angiography after perimesencephalic subarachnoid hemorrhage? J Neuroradiol. 2006;33:87–9.

    Article  PubMed  CAS  Google Scholar 

  30. Topcuoglu MA, Ogilvy CS, Carter BS, Buonanno FS, Koroshetz WJ, Singhal AB. Subarachnoid hemorrhage without evident cause on initial angiography studies: diagnostic yield of subsequent angiography and other neuroimaging tests. J Neurosurg. 2003;98:1235–40.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China

    Yuhan Kong & Xinyue Qin

  2. Department of Physiology and Pharmacology, Loma Linda University, Loma Linda, CA, USA

    John H. Zhang

  3. Department of Neurosurgery, Loma Linda University, Loma Linda, CA, USA

    John H. Zhang

  4. Department of Anesthesiology, Loma Linda University, Loma Linda, CA, USA

    John H. Zhang

Authors
  1. Yuhan Kong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John H. Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xinyue Qin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xinyue Qin .

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Gaotanyan 30, Chongqing, 400038, China

    H.-J. Steiger  & Hua Feng  & 

  2. Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China

    Ying Mao

  3. Departments of Physiology and Neurosurgery, Loma Linda University School of Medicine, Risley Hall, Room 223, 92354, Loma Linda, California, USA

    John H. Zhang

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag/Wien

About this paper

Cite this paper

Kong, Y., Zhang, J.H., Qin, X. (2011). Perimesencephalic Subarachnoid Hemorrhage: Risk Factors, Clinical Presentations, and Outcome. In: Feng, H., Mao, Y., Zhang, J.H. (eds) Early Brain Injury or Cerebral Vasospasm. Acta Neurochirurgica Supplements, vol 110/1. Springer, Vienna. https://doi.org/10.1007/978-3-7091-0353-1_34

Download citation

  • DOI: https://doi.org/10.1007/978-3-7091-0353-1_34

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-7091-0352-4

  • Online ISBN: 978-3-7091-0353-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation