Purpose Non-aneurysmal perimesencephalic subarachnoid hemorrhage (PmSAH) represents 6.8% of spontaneous subarachnoid hemorrhage, and usually has a benign clinical course. However, patients might have early cerebral ischemic lesions and long-term neurocognitive complaints. Cerebral atrophy has been described in patients after aneurysmal SAH, but not in PmSAH. We aimed to investigate if PmSAH associates with increased brain volume loss. Methods In this prospective study, we included consecutive patients with PmSAH that performed MR in the first 10 days after hemorrhage, and follow-up MR 6-7 years later. Automated volumetric measurements of intracranial, white matter, gray matter, whole brain, lateral ventricles, hippocampus, and amygdala volumes were performed. Volumes were compared to a normal population, matched for age. Results Eight patients with PmSAH were included, with a mean age of 51.5 (SE 3.6) at baseline. The control group included 22 patients with a mean age of 56.3 (SE 2.0). A relative reduction of all volumes was found in both groups; however, PmSAH patients had significant reductions in intracranial, white and gray matter, whole brain, and hippocampal volumes when compared to controls. These changes had a higher magnitude in whole brain volume, with a significant absolute decrease of 6.5% in PmSAH patients (versus 1.9% in controls), and a trend for an increase in lateral ventricle volume (absolute 21.3% increase, versus 3.9% in controls). Conclusion Our cohort of PmSAH patients showed significant long-term parenchymal atrophy, and higher global and focal parenchymal volume loss rates when compared to a non-SAH population.

Background Idiopathic intracranial hypertension (IIH) has well-described imaging findings, typically reversible with the adequate treatment. We hereby report a case of IIH with a peculiar imaging finding, that to our knowledge and by the research conducted, has never been described before—cerebro-spinal fluid (CSF) transudation across the optic nerve sheath. Case presentation A 15-year-old girl with a 2-week history of occipital headache, nausea and vomiting, diplopia, blurred vision and tinnitus in her right ear, was admitted in the neuropediatric department and after extensive diagnostic work-up was diagnosed with IIH. The MRI showed typical signs of idiopathic intracranial hypertension, including enlargement of the perioptic CSF spaces associated with a peculiar finding described as a blurred hyperintensity T2/FLAIR of the perioptic fat, which was likely related to transudation of CSF. The adequate medical therapy (including corticosteroids and acetazolamide) for 2 weeks didn’t revert the signs and symptoms and so a lumboperitoneal shunt was placed with complete resolution of the clinical picture and the imaging findings described. Conclusions The documentation of CSF transudation around the optic nerve in the setting of hydrops has never been reported before and should be recognized by the neuroradiologist. It seems to be reversible, like the other findings of IIH and its physiopathology is not clear.

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