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

Kong, Yuhan; Zhang, Junyi; Qin, Xinyue

doi:10.1007/978-3-7091-0353-1_34

Cited by 15 publications

(22 citation statements)

References 26 publications

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“…Our data shows growing numbers of this bleeding type (Fig. 1), but data on patients with angiogram-negative and NPM-SAH is not so often [1,7,8,11,12,[24][25][26][27] and scarce for series with more than 50 patients [5,15,16]. Therefore, our institutional data was analyzed, and 68 patients (5.7 %) suffering from angiogramnegative and NPM-SAH were identified.…”

Section: Discussionmentioning

confidence: 96%

“…SD standard deviation, NS not significant (p>0.05), WFNS world federation of neurological societies, OR odds ratio, CI confidence interval a Unpaired t test and mean difference for parametric statistics and χ 2 test and odds ratio for categorical variables NPM-SAH pattern on initial CT scan [1,5,7,8,11,12,15,16,24,25,27].…”

Section: Incidence Of Non-aneurysmal Npm-sah and Neurological Conditimentioning

confidence: 99%

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Clinical outcome and prognostic factors of patients with angiogram-negative and non-perimesencephalic subarachnoid hemorrhage: benign prognosis like perimesencephalic SAH or same risk as aneurysmal SAH?

et al. 2014

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Subarachnoid hemorrhage (SAH) is usually caused by a ruptured intracranial aneurysm. However, in some patients, no source of hemorrhage might be detected despite repeated digital subtraction angiography (DSA). Our objective was to analyze factors influencing the clinical outcome in patients suffering from non-aneurysmal and non-perimesencephalic (NPM) SAH. Between 1999 and 2011, 68 of 1,188 patients with SAH (5.7%) suffered from non-aneurysmal and NPM-SAH. Outcome was assessed according to the modified Rankin Scale (mRS) at 6 months (mRS 0-2 favorable vs. 3-6 unfavorable). In patients with angiogram-negative and NPM-SAH, favorable outcome was achieved in 56 patients (82.4%). In the multivariate analysis, age <65 years and non-Fisher 3 bleeding pattern were significantly associated with favorable outcome. Angiogram-negative and NPM-SAH had good prognoses. Patients with non-Fisher-type 3 bleeding had excellent outcomes similar to patients with perimesencephalic SAH, but patients with Fisher-type 3 bleeding were at risk for poor outcome like aneurysmal SAH patients due to cerebral vasospasm and delayed cerebral ischemia. Age and bleeding type were detected as prognostic factors in the multivariate analysis.

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Section: Discussionmentioning

confidence: 96%

Section: Incidence Of Non-aneurysmal Npm-sah and Neurological Conditimentioning

confidence: 99%

Clinical outcome and prognostic factors of patients with angiogram-negative and non-perimesencephalic subarachnoid hemorrhage: benign prognosis like perimesencephalic SAH or same risk as aneurysmal SAH?

et al. 2014

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“…Semptomatik tedavi, kardiyak monitörizasyon, hidrosefali takibi, serum biyokimyası kontrolü, zorlayıcı hareketlerden kaçınma ve hipertansiyon kontrolü de önerilir (3). Uzun dönem takip edilen vakalarda baş ağrısı ve psikiyatrik semptomlar bildirilmiştir (15). Bizim olgularımızın takiplerinde de zaman zaman baş ağrıları ve bu ağrılar ile tetiklenen anksiyete belirtileri gözlenmiştir.…”

Section: Discussionunclassified

Non-Aneurysmal Perimesencephalic Subarachnoid Hemorrhage: 6 Cases

Selçuk¹,

Çabalar²,

Güveli³

et al. 2013

Türk Beyin Damar Hast Derg

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Subaraknoid kanamalar (SAK) orta-ileri yaş grubunda önemli bir morbidite ve mortalite nedenidir. Yaklaşık %85 nedeni anevrizmaların rüptürüdür. Nadir karşılaşılan bir formu olan non-anevrizmal perimezensefalik subaraknoid kanama (N-APMSAK)'larda, anevrizma kökenli SAK'ların aksine yeniden kanama riski çok düşük bir orandadır ve prognoz çok daha iyidir. Nadir görülen N-APMSAK semptomatoloji açısından anevrizmal SAK'lara benzemekle birlikte iyi prognoza sahip olması ile subaraknoid kanamanın diğer formlarından farklılık gösterir. İyi tanınması komplikasyonu arttırabilecek olan gereksiz tetkiklerin ve cerrahi müdahalenin önlenmesi açısından önemlidir. Bu yazıda şiddetli baş ağrısı yakınmasıyla başvuran N-APMSAK tanısı ile Nöroloji kliniğimizde takip ettiğimiz 6 olgu sunulmuştur. Anahtar Sözcükler: Perimezensefalik subaraknoid kanama, tanı, prognoz. NON-ANEURYSMAL PERIMESENCEPHALIC SUBARACHNOID HEMORRHAGE: 6 CASES ABSTRACTSubarachnoid hemorrhage (SAH) is an important cause of mortality and morbidity in middle-age and elderly people. Although aneurysm ruptures are the most frequent causes of SAH, it cannot be identified in approximately 15% of the cases. However, the onset symptoms are similar, perimesencephalic non-aneurysmal SAH can be differentiated by benign prognosis from other forms. Its early diagnosis may prevent unnecessary neuroradiological and surgical procedures. In this study, 6 patients who admitted to Neurology Department with severe headache and detected hemorrhagic appearance around the mesencephalon (pretruncal) on computerized tomography were presented.

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“…However, according to the previous studies [3, 4], even though there is now widespread use of digital subtraction angiogram (DSA) to aid in the diagnosis of spontaneous SAH, nearly fifteen percent of cases remain idiopathic [4]. This category of SAH has been termed nonaneurysmal SAH (NASAH), which typically follows a benign clinical course and has a generally favorable prognosis when compared with aneurysmal subarachnoid hemorrhage (aSAH) [5, 6]. …”

Section: Introductionmentioning

confidence: 99%

“…Although it is generally recognized that NASAH has a more preferable outcome than aSAH [5], recent studies suggest that the management of the nPMN-SAH subgroup should be more rigorous in light of its more severe clinical courses and outcomes [8, 9]. As nPMN-SAH is a diagnosis of exclusion, some controversial issues remain regarding the management of these patients that have negative initial DSA findings [10, 11].…”

Section: Introductionmentioning

confidence: 99%

Management of Spontaneous Subarachnoid Hemorrhage Patients with Negative Initial Digital Subtraction Angiogram Findings: Conservative or Aggressive?

Fang

Shi

et al. 2017

BioMed Research International

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Background. The ideal management of SAH patients with negative initial DSA findings remains unresolved. Objective. (i) To present risk factors, clinical courses, and outcomes in different types of SAH patients with negative DSA findings; (ii) to explore the differences of basal vein between aSAH patients and NASAH patients; and (iii) to evaluate the value of repeated DSA for these patients. Methods. All SAH patients with negative initial DSA findings between 2013 and 2015 in our hospital were enrolled and were further categorized as perimesencephalic SAH (PMN-SAH) or nonperimesencephalic SAH (nPMN-SAH). Risk factors, clinical courses, outcomes, and the basal vein drainage patterns were compared. Results. A total of 137 patients were enrolled in the present study. The PMN-SAH group had better GOS and mRS values at 1-year follow-up. Moreover, the nPMN-SAH group had a higher rate of complications. The basal vein drainage pattern showed significant difference when comparing each of the NASAH subtypes with aSAH groups. There was a significant higher rate of a responsible aneurysm in nPMN-SAH group upon repeated DSA. Conclusions. SAH patients with negative initial DSA findings had benign clinical courses and outcomes. Repeated DSA studies are strongly advised for patients with the nPMN-SAH pattern.

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

Cited by 15 publications

References 26 publications

Clinical outcome and prognostic factors of patients with angiogram-negative and non-perimesencephalic subarachnoid hemorrhage: benign prognosis like perimesencephalic SAH or same risk as aneurysmal SAH?

Clinical outcome and prognostic factors of patients with angiogram-negative and non-perimesencephalic subarachnoid hemorrhage: benign prognosis like perimesencephalic SAH or same risk as aneurysmal SAH?

Non-Aneurysmal Perimesencephalic Subarachnoid Hemorrhage: 6 Cases

Management of Spontaneous Subarachnoid Hemorrhage Patients with Negative Initial Digital Subtraction Angiogram Findings: Conservative or Aggressive?

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