Li Juan, Fang Xiang, Yu Fu-Chao, Du Bin
Operating Room Nurse, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan 250000, Shandong Province, China.
Department of Neurosurgery, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan 250000, Shandong Province, China.
World J Clin Cases. 2021 May 16;9(14):3356-3364. doi: 10.12998/wjcc.v9.i14.3356.
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.
自发性蛛网膜下腔出血（SAH）主要由颅内动脉瘤破裂引起。中脑周围非动脉瘤性SAH（PNSAH）约占所有自发性SAH的5%。PNSAH预后良好。出血复发风险低。我们报告一例PNSAH复发病例，该病例发生在未接受抗血栓或抗血小板药物治疗的患者首次发作后的短时间内。
一名66岁男性，近期无任何外伤史，未服用抗血栓/抗血小板药物，突发两次类似的严重头痛、恶心和呕吐发作。头颅计算机断层扫描（CT）平扫显示蛛网膜下腔出血局限于脑干前部。血小板计数和凝血功能正常。通过重复头颅CT、磁共振成像和脑血管造影诊断为PNSAH，均未发现SAH的来源。患者出院时无局灶性神经功能缺损。在6个月的随访中，患者未出现严重头痛突发情况，临床预后良好。研究报告了少数复发性PNSAH患者，其出血常源于静脉出血，通常与静脉异常有关。PNSAH在症状首次出现后的短时间内复发，尽管再次出血的可能性极其罕见。
PNSAH复发应引起警惕；然而，本病例报告中特发性SAH的确切来源值得进一步关注。
