Abstract
IntroductionBoth aneurysmal subarachnoid hemorrhage and benign perimesencephalic hemorrhage are well-described causes of spontaneous subarachnoid hemorrhage that arise as a result of different pathologic processes. To the best of the authors' knowledge, there have been no reports of both vascular pathologies occurring in the same individual.Case presentationA 51-year-old Caucasian woman with a history of aneurysmal subarachnoid hemorrhage presented five years after her initial treatment with ictal headache, meningismus, nausea and emesis similar to her previous bleeding event. Computed tomographic imaging revealed perimesencephalic bleeding remote from her previously coiled anterior communicating artery aneurysm. Both immediate and delayed diagnostic angiography revealed no residual filling of the previously coiled aneurysm and no other vascular anomalies, consistent with benign perimesencephalic hemorrhage. The patient had an uneventful hospital course and was discharged to home in good condition.ConclusionsThis report for the first time identifies benign perimesencephalic hemorrhage occurring in the setting of previous aneurysmal subarachnoid hemorrhage. The presence of a previously treated aneurysm can complicate the process of diagnosing benign perimesencephalic hemorrhage. Fortunately, in this case, the previously treated anterior communicating artery aneurysm was remote from the perimesencephalic hemorrhage and could be ruled out as a source. The patient's prior aneurysmal subarachnoid hemorrhage did not worsen the anticipated good outcome associated with benign perimesencephalic hemorrhage.
Highlights
Both aneurysmal subarachnoid hemorrhage and benign perimesencephalic hemorrhage are welldescribed causes of spontaneous subarachnoid hemorrhage that arise as a result of different pathologic processes
This report for the first time identifies benign perimesencephalic hemorrhage occurring in the setting of previous aneurysmal subarachnoid hemorrhage
The patient’s prior aneurysmal subarachnoid hemorrhage did not worsen the anticipated good outcome associated with benign perimesencephalic hemorrhage
Summary
This work represents the first report of both aneurysmal SAH and non-aneurysmal BPH occurring in the same individual. The diagnosis of BPH may be complicated by previous aneurysmal SAH. The expected good prognosis associated with BPH does not appear to be altered by a previous episode of aneurysmal SAH. To those in the fields of neurology and neurosurgery, this case serves as an important reminder that in patients with a history of previous aneurysmal SAH, subsequent episodes of SAH need to be fully investigated because they may be attributable to an entirely different pathology. Consent Written informed consent was obtained from the patient for publication of this case report and accompanying images. MH was responsible for the patient’s original aneurysmal management and supervised her case on her subsequent admission. Competing interests The authors declare that they have no competing interests
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
