Published online May 16, 2021. doi: 10.12998/wjcc.v9.i14.3356
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
Processing time: 172 Days and 18.2 Hours
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.
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.
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.