Non-aneurysmal perimesencephalic subarachnoid saemorrhage is characterized by an accumulation of blood in the perimesencephalic and prepontine cisterns identified on sectional imaging together with persistently negative cerebral angiography. Magnetic resonance imaging usually contributes no further information on the possible cause of the bleed but may occasionally show further features including associated parenchymal infarcts such as the pontine haemorrhagic infarct seen in the case described here.
SchwartzTHSolomonRA: Perimesencephalic nonaneurysmal subarachnoid haemorrhage: Review of the literature. Neurosurgery39: 433–440, 1996.
2.
SettonADavisAJ: Angiography of Cerebral Aneurysms. Neuroimag Clin North Am: 705–738, 1996.
3.
DuongHMelanconD: The negative angiogram in subarachnoid haemorrhage. Neuroradiology38: 15–19, 1996.
4.
de Mesnil de RochemontR: Nontraumatic subarachnoid haemorrhage: Value of repeat angiography. Radiology202: 798–800, 1997.
5.
UrbachHZentnerJ: The need for repeat angiography in subarachnoid haemorrhage. Neuroradiology40: 6–10, 1998.
6.
MorrisP: Aneurysms, Subarachnoid Haemorrhage and Dissections. In: MorrisP, ed Practical Neuroangiography. Willems and Willems, Baltimore1997: 281–315.
7.
HashimotoHIidaJ: Use of spiral computerized tomography angiography in patients with subarachnoid haemorrhage in whom subtraction angiography did not reveal cerebral aneurysms. J Neurosurg92: 278–283, 2000.
8.
ForsterDMCSteinerL: The value of repeat pan-angiography in cases of unexplained subarachnoid haemorrhage. J Neurosurg48: 712–716, 1978.
9.
GilbertJWLeeC: Repeat cerebral pan-angiography in subarachnoid haemorrhage of unknown aetiology. Surg Neurol33: 19–21, 1990.
10.
TatterSBCromwellRM: Aneurysmal and microaneurysmal “angiogram-negative” subarachnoid hemorrhage. Neurosurgery37: 48–55, 1995.
11.
SchievinkWIWijdicksEF: Perimesencephalic subarachnoid haemorrhage. Additional perspectives from four cases. Stroke25: 1507–1511, 1994.
12.
RinkelGJvan GijnJ: Subarachnoid haemorrhage without detectable aneurysm. A review of the causes. Stroke24: 1403–1409, 1993.
13.
BagleyLJHurstRW: Angiographic evaluation of aneurysms affecting the central nervous system. Neuroimag Clin North Am7: 721–737, 1997.
14.
Van GijnJvan DongenKJ: Perimesencephalic haemorrhage: A nonaneurysmal and benign form of subarachnoid haemorrhage. Neurology35: 493–497, 1985.
15.
CanhaoPFerroJM: Perimesencephalic and non-perimesencephalic subarachnoid haemorrhages with negative angiograms. Acta neurochir132: 14–19, 1995.
RinkelGJWijdicksEF: Nonaneurysmal perimesencephalic subarachnoid haemorrhage: CT and MR patterns that differ from aneurysmal rupture. Am J Neuroradiol12: 829–834, 1991.
18.
FranzGBrenneisC: Prognostic value of intraventricular blood in perimesencephalic nonaneurysmal subarachnoid hemorrhage. J Comput Assist Tomogr25: 742–746, 2001.
19.
PintoANFerroJM: How often is a perimesencephalic subarachnoid haemorrhage CT pattern caused by ruptured aneurysms?Acta Neurochir124: 79–81, 1993.
20.
KallmesDFClarkHP: Ruptured vertebrobasilar aneurysm: Frequency of the nonaneurysmal perimesencephalic pattern of haemorrhage on CT scans. Radiology201: 657–660, 1996.
21.
Van CalenberghFPletsC: Nonaneurysmal subarachnoid haemorrhage: Prevalence of perimesencephalic haemorrhage in a consecutive series. Surg Neurol39: 320–323, 1993.
22.
Van GijnJRinkelGJ: Subarachnoid haemorrhage: Diagnosis, causes and management. Brain124: 249–278, 2001.
23.
SchievinkWIWijdicksEF: Pretruncal subarachnoid haemorrhage: an anatomically correct description of the perimesencephalic subarachnoid haemorrhage. Stroke28: 2572, 1997.
RinkelGJEWijdicksEFM: The clinical course of perimesencephalic nonaneurysmal subarachnoid haemorrhage. Ann Neurol29: 463–468, 1991.
26.
WijdicksEFMSchievinkWI: Pretruncal nonaneurysmal subarachnoid haemorrhage. Mayo Clin Proc73: 745–752, 1998.
27.
SchievinkWIWijdicksEF: Diffuse vasospasm after pretruncal nonaneurysmal subarachnoid haemorrhage. Am J Neuroradiol21: 521–523, 2000.
28.
RinkelGJWijdicksEFM: Acute hydrocephalus in nonaneurysmal perimesencephalic haemorrhage: Evidence of cerebrospinal fluid block at the tentorial hiatus. Neurology42: 1805–1807, 1992.
29.
MarquardtGNiebauerT: Long term follow-up after perimesencephalic subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry69: 127–130, 2000.
30.
RinkelGJWijdicksEF: Outcome in perimesencephalic (nonaneurysmal) subarachnoid haemorrhage: A follow-up study in 37 patients. Neurology40: 1130–1132, 1990.
31.
RinkelGJWijdicksEF: Outcome in patients with subarachnoid haemorrhage and negative angiography according to the pattern of haemorrhage and negative angiography according to the pattern of haemorrhage on computed tomography. Lancet338: 964–968, 1991.
32.
BrilstraEHHopJW: Quality of life after perimesencephalic haemorrhage. J Neurol Neurosurg Psychiatry63: 382–384, 1997.
33.
MadureiraSCanhaoP: Cognitive and emotional consequences of perimesencephalic haemorrhage. J Neurol247: 862–867, 2000.
34.
SchievinkWIWijdicksEF: Origin of pretruncal nonaneurysmal subarachnoid haemorrhage: Ruptured vein, perforating artery, or intramural haematoma?Mayo Clin Proc75: 1169–1173, 2000.
35.
OgiichiTEndoS: Non-aneurysmal subarachnoid haemorrhage associated with basilar artery dissection - autopsy case report. Neurol Med Chir37: 612–615, 1997.
36.
RoggJMSmeatonS: Assessment of the value of MR imaging for examining patients with angiographic negative subarachnoid haemorrhage. Am J Radiol172: 201–206, 1999.
37.
HochbergFHFisherCM: Subarachnoid haemorrhage caused by rupture of a small superficial artery. Neurology24: 319–321, 1974.
38.
KukerWThiexR: Hyperacute perimesencephalic subarachnoid haemorrhage: demonstration of blood extravasation with MRI: J Comput Assist Tomogr23: 521–523, 1999.
WijdicksEFSchievinkWI: MR imaging in pretruncal non-aneurysmal subarachnoid haemorrhage: is it worthwhile?Stroke29: 2514–1516, 1998.
41.
TatterSBBuonanoFS: Acute lacunar stroke in association with angiogram - negative subarachnoid haemorrhage: mechanistic implications of two cases. Stoke26: 891–895, 1995.
42.
RuigrokYMRinkelGJ: Perimesencephalic haemorrhage and CT angiography: A decision analysis. Stroke31: 2976–2983, 2000.
43.
IshiharaSRossIB: 3D Rotational angiography; Recent experience in the evaluation of cerebral aneurysms for treatment. Interventional Neuroradiology6: 85–94, 2000.
