Li J, Fang X, Yu FC, Du B. Recurrent perimesencephalic nonaneurysmal subarachnoid hemorrhage within a short period of time: A case report. World J Clin Cases 2021; 9(14): 3356-3364 [PMID: 34002145 DOI: 10.12998/wjcc.v9.i14.3356]
Corresponding Author of This Article
Bin Du, MS, Department of Neurosurgery, Jinan Central Hospital Affiliated to Shandong First Medical University, No. 105 Jiefang Road, Lixia District, Jinan 250000, Shandong Province, China. dubint@163.com
Research Domain of This Article
Neurosciences
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. May 16, 2021; 9(14): 3356-3364 Published online May 16, 2021. doi: 10.12998/wjcc.v9.i14.3356
Recurrent perimesencephalic nonaneurysmal subarachnoid hemorrhage within a short period of time: A case report
Juan Li, Xiang Fang, Fu-Chao Yu, Bin Du
Juan Li, Operating Room Nurse, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan 250000, Shandong Province, China
Juan Li, Operating Room Nurse, Jinan Central Hospital Affiliated to Shandong University, Jinan 250000, Shandong Province, China
Xiang Fang, Fu-Chao Yu, Bin Du, Department of Neurosurgery, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan 250000, Shandong Province, China
Xiang Fang, Fu-Chao Yu, Bin Du, Department of Neurosurgery, Jinan Central Hospital Affiliated to Shandong University, Jinan 250000, Shandong Province, China
Author contributions: Li J and Du B carried out the studies, participated in collecting data, and drafted the manuscript; Fang X performed the statistical analysis and participated in its design; Yu FC helped to draft the manuscript; all authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bin Du, MS, Department of Neurosurgery, Jinan Central Hospital Affiliated to Shandong First Medical University, No. 105 Jiefang Road, Lixia District, Jinan 250000, Shandong Province, China. dubint@163.com
Received: November 7, 2020 Peer-review started: November 7, 2020 First decision: December 30, 2020 Revised: February 1, 2021 Accepted: March 8, 2021 Article in press: March 8, 2021 Published online: May 16, 2021
Abstract
BACKGROUND
Spontaneous subarachnoid hemorrhage (SAH) is primarily caused by a ruptured intracranial aneurysm. Perimesencephalic nonaneurysmal SAH (PNSAH) accounts for approximately 5% of all spontaneous SAH. PNSAH displays favorable prognosis. The risk of hemorrhage recurrence is low. We report a case of PNSAH recurrence, occurring within a short time after the initial episode in a patient not receiving antithrombotic or antiplatelet drugs.
CASE SUMMARY
A 66-year-old male, without any history of recent trauma or antithrombotic/ antiplatelet medication, suffered two similar episodes of sudden onset of severe headache, nausea, and vomiting. A plain head computed tomography (CT) scan showed subarachnoid blood confined to the anterior part of the brainstem. Platelet count and coagulation function were normal. PNSAH was diagnosed by repeated head CT, magnetic resonance imaging, and cerebral angiography, none of which revealed the source of SAH. The patient was discharged without focal neurological deficits. At 6-mo follow-up, the patient had experienced no sudden onset of severe headache and presented favorable clinical outcome. Studies have reported a few patients with recurrent PNSAH, originating frequently from venous hemorrhage and conventionally associated with venous abnormalities. PNSAH recurs within a short time following the initial onset of symptoms, although the possibility of re-hemorrhage is extremely rare.
CONCLUSION
PNSAH recurrence should arouse vigilance; however, the definite source of idiopathic SAH in this case report deserves further attention.
Core Tip: Relevant cases of spontaneous subarachnoid hemorrhage (SAH) recurrence, the underlying mechanisms and possible etiology were reviewed. Perimesencephalic nonaneurysmal SAH (PNSAH) recurrence should arouse vigilance; however, the definite source of idiopathic SAH in this case report deserves further attention. Furthermore, patients should be advised regarding the potential recurrence of PNSAH.
