Perimesencephalic subarachnoid hemorrhage

Starting from a case with prepontine subarachnoid hemorrhage, we review this rather obscure topic, which has been neglected by research; perhaps this is due to the laconic nature of the disease: sounds dangerous, yet is benign most of times.

Here are the core facts:

  • It seems to be caused by aneurysm in at most 9% and thus the rate of rebleeding is not as high as proper (base) SAH.
  • As for other nonaneurysmal SAH, rare causes are venous thrombosis, dissection, (spinal and other) arteriovenous malformations
  • Most of the time the etiology is unclear, but it might be due to rupture of a perforating artery (even has been shown pathologically in one instance) and thus has a similar prognosis as loco typico ICH (without the tough neurological consequences).
  • As for management, there is no proper guideline, yet you do well if you treat it just as SAH, i.e., very carefully (do an angio, give nimodipine and lactulose, reduce RR and prepare for complications)

As for reference, there are no current reviews, so I used uptodate. There is a case series in this free article, which is not too old. Yet the last proper review is from 1996.

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