Gravino Gilbert, Abdelsalam Nasr, Patel Jay, Aamir Saad, Babatola Feyi, Chandran Arun
Neuroradiology Department, The Walton Centre NHS Foundation Trust, Liverpool, UK.
School of Pharmacy and Bioengineering, Keele University, Stoke on Trent, UK.
J Med Case Rep. 2025 Apr 8;19(1):166. doi: 10.1186/s13256-024-04950-0.
Subarachnoid hemorrhage in the basal cisterns is usually identified on an unenhanced computed tomography scan of the head in patients presenting acutely with a characteristic sudden onset headache.
Using imaging examples from our tertiary neurosciences center, we present six cases demonstrating a variety of causes for subarachnoid hemorrhage in the basal cisterns, ranging from benign to sinister causes. These include a venous perimesencephalic hemorrhage (35 years, female), pontine perforator aneurysm (54 years, male), vertebral artery dissection (69 years, male), cervical dural arteriovenous fistula (65 years, male), posterior fossa arteriovenous malformation (45 years, male), and vertebral artery aneurysm (78 years, female). Ethnically, all these patients were white. Specific imaging features are described and demonstrated.
A balance between avoiding excessive investigation and overlooking what may be a mimic of a venous perimesencephalic hemorrhage is important. To refine and establish more definitive indications on when to perform computed tomography angiogram, digital subtraction angiography, delayed angiography and magnetic resonance imaging in this context requires future research to focus on large-scale prospective multicenter studies with robust data.
在以突发特征性头痛急性就诊的患者中，基底池蛛网膜下腔出血通常可通过头部非增强计算机断层扫描识别。
利用我们三级神经科学中心的影像学实例，我们展示了6例基底池蛛网膜下腔出血病因各异的病例，病因从良性到恶性不等。这些病因包括静脉性中脑周围出血（35岁，女性）、脑桥穿通支动脉瘤（54岁，男性）、椎动脉夹层（69岁，男性）、颈硬膜动静脉瘘（65岁，男性）、后颅窝动静脉畸形（45岁，男性）以及椎动脉动脉瘤（78岁，女性）。从种族上看，所有这些患者均为白人。文中描述并展示了具体的影像学特征。
在避免过度检查与忽视可能类似静脉性中脑周围出血的情况之间取得平衡很重要。在此背景下，要完善并确定何时进行计算机断层血管造影、数字减影血管造影、延迟血管造影和磁共振成像的更明确指征，未来的研究需要聚焦于大规模前瞻性多中心研究并获取可靠数据。
