Nontraumatic convexity subarachnoid hemorrhage with ischemic stroke: report of four cases and literature review

Abstract

Objective Nontraumatic convexity subarachnoid hemorrhage (cSAH) complicating acute ischemic stroke is rare.Here we report four cases and review the relevant literature. Methods All cSAH cases at Peking University Third Hospital between January 2010 and December 2014 were collected and those associated with acute cerebral infarction were identified.Clinical medical records, neuroimaging data, treatment and prognosis were retrospectively reviewed. Results We found four cSAH patients with co-existing acute cerebral infarction.Two had ipsilateral middle cerebral artery (MCA) stenosis, one had ipsilateral internal carotid artery (ICA) stenosis, and the fourth case did not present significant cerebrovascular stenosis on magnetic resonance angiogram but had atrial fibrillation.All patients underwent brain magnetic resonance imaging (MRI) and none showed signs of cerebral amyloid angiopathy.One patient took oral Plaix because of the progression of ischemic stroke and the other three did not receive oral antiplatelet medications Three patients who were followed up for one to three years remained in stable condition. Conclusions Patients with cSAH complicated by ischemic stroke usually have a good prognosis.Most patients show significant atherosclerotic stenosis of ipsilateral vessels.MRI and assessment of extracranial and intracranial cerebral vessels for cSAH patients are recommended. Key words: Subarachnoid hemorrhage; Cerebral stenosis; Brain infarction