Presentation
Headache for four days, subarachnoid hemorrhage suspected.
Patient Data
Age: 60 years
Gender: Male
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A small amount of subarachnoid hemorrhage in the basal cisterns located mainly anterior to the midbrain.
CTA of the cerebral arteries
From the case:
Non-aneurysmal perimesencephalic subarachnoid hemorrhage
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Subsequently obtained brain CTA excluded clinically suspected basilar artery aneurysm as a source of hemorrhage.
Case Discussion
Although in the case of perimesencephalic subarachnoid hemorrhage (PMSAH), CTA is a recommended further imaging investigation for the exclusion of vertebrobasilar artery aneurysm, the vast majority of PMSAH are non-aneurysmal in origin. It's worth to keep that in mind to avoid unnecessary DSA investigation in negative CTA scan as in this case.
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