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Perimesencephalic Nonaneurysmal Subarachnoid Hemorrhage
Anne G. Osborn, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Perimesencephalic nonaneurysmal subarachnoid hemorrhage (pnSAH)
            • Synonyms

              • Perimesencephalic SAH
            • Definitions

              • SAH centered anterior to midbrain ± pons
              • No source demonstrated at angiography

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Angiographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Flores G et al: Descriptive study of aneurysmal and nonaneurysmal subarachnoid hemorrhage and the role of confirmative digital subtraction angiography in patients with nonaneurysmal subarachnoid in Puerto Rico. World Neurosurg. 134:e481-6, 2020
                                        2. Atchie B et al: Comparing outcomes of patients with idiopathic subarachnoid hemorrhage by stratifying perimesencephalic bleeding patterns. J Stroke Cerebrovasc Dis. 28(9):2407-13, 2019
                                        3. qDerraz I et al: Recurrent bleeding after perimesencephalic hemorrhage: case report and review of the literature. World Neurosurg. 129:287-91, 2019
                                        4. Fragata I et al: Ischemic lesions in acute and subacute perimesencephalic subarachnoid hemorrhage. AJR Am J Roentgenol. 212(2):418-24, 2019
                                        5. Fragata I et al: Comparison of cerebral perfusion in perimesencephalic subarachnoid hemorrhage and aneurysmal subarachnoid hemorrhage. Neuroradiology. 60(6):609-16, 2018
                                        6. Marder CP et al: Subarachnoid hemorrhage: beyond aneurysms. AJR Am J Roentgenol. 202(1):25-37, 2014
                                        7. Buyukkaya R et al: The relationship between perimesencephalic subarachnoid hemorrhage and deep venous system drainage pattern and calibrations. Clin Imaging. 38(3):226-30, 2014
                                        8. Kapadia A et al: Nonaneurysmal perimesencephalic subarachnoid hemorrhage: diagnosis, pathophysiology, clinical characteristics and long-term outcome. World Neurosurg. 82(6):1131-43, 2014
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Pathology

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Abbreviations

                                                    • Perimesencephalic nonaneurysmal subarachnoid hemorrhage (pnSAH)
                                                  • Synonyms

                                                    • Perimesencephalic SAH
                                                  • Definitions

                                                    • SAH centered anterior to midbrain ± pons
                                                    • No source demonstrated at angiography

                                                  IMAGING

                                                  • General Features

                                                    • CT Findings

                                                      • MR Findings

                                                        • Angiographic Findings

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Gross Pathologic & Surgical Features

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Natural History & Prognosis

                                                                        • Treatment

                                                                          DIAGNOSTIC CHECKLIST

                                                                          • Consider

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Flores G et al: Descriptive study of aneurysmal and nonaneurysmal subarachnoid hemorrhage and the role of confirmative digital subtraction angiography in patients with nonaneurysmal subarachnoid in Puerto Rico. World Neurosurg. 134:e481-6, 2020
                                                                              2. Atchie B et al: Comparing outcomes of patients with idiopathic subarachnoid hemorrhage by stratifying perimesencephalic bleeding patterns. J Stroke Cerebrovasc Dis. 28(9):2407-13, 2019
                                                                              3. qDerraz I et al: Recurrent bleeding after perimesencephalic hemorrhage: case report and review of the literature. World Neurosurg. 129:287-91, 2019
                                                                              4. Fragata I et al: Ischemic lesions in acute and subacute perimesencephalic subarachnoid hemorrhage. AJR Am J Roentgenol. 212(2):418-24, 2019
                                                                              5. Fragata I et al: Comparison of cerebral perfusion in perimesencephalic subarachnoid hemorrhage and aneurysmal subarachnoid hemorrhage. Neuroradiology. 60(6):609-16, 2018
                                                                              6. Marder CP et al: Subarachnoid hemorrhage: beyond aneurysms. AJR Am J Roentgenol. 202(1):25-37, 2014
                                                                              7. Buyukkaya R et al: The relationship between perimesencephalic subarachnoid hemorrhage and deep venous system drainage pattern and calibrations. Clin Imaging. 38(3):226-30, 2014
                                                                              8. Kapadia A et al: Nonaneurysmal perimesencephalic subarachnoid hemorrhage: diagnosis, pathophysiology, clinical characteristics and long-term outcome. World Neurosurg. 82(6):1131-43, 2014