Singleton Richard H, Kostov Dean B, Kanaan Hilal A, Horowitz Michael B
Department of Neurological Surgery, University of Pittsburgh Medical Center, Suite B-400, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
J Med Case Rep. 2010 Dec 14;4:405. doi: 10.1186/1752-1947-4-405.
Both 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.
A 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.
This 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.
动脉瘤性蛛网膜下腔出血和良性中脑周围出血都是因不同病理过程导致的自发性蛛网膜下腔出血的常见病因。据作者所知，尚无同一患者同时发生这两种血管病变的报道。
一名51岁的白种女性，有动脉瘤性蛛网膜下腔出血病史，在初次治疗五年后出现发作性头痛、颈项强直、恶心和呕吐，症状与她之前的出血事件相似。计算机断层扫描成像显示中脑周围出血，远离她之前已栓塞的前交通动脉瘤。即时和延迟诊断性血管造影均显示先前栓塞的动脉瘤无残余造影剂充盈，也无其他血管异常，符合良性中脑周围出血。患者住院过程顺利，出院时情况良好。
本报告首次发现既往有动脉瘤性蛛网膜下腔出血病史的患者发生良性中脑周围出血。既往治疗过的动脉瘤的存在会使良性中脑周围出血的诊断过程复杂化。幸运的是，在本病例中，先前治疗的前交通动脉瘤远离中脑周围出血，可排除其为出血源。患者既往的动脉瘤性蛛网膜下腔出血并未使与良性中脑周围出血相关的预期良好预后恶化。
