• Edgar A Samaniego, Guilherme Dabus, Karel Fuentes, and Italo Linfante.
• Baptist Cardiac and Vascular Institute, 8900 N Kendall Drive, Miami, FL 33176, USA. edgarsama@gmail.com
• Neurocrit Care. 2011 Dec 1;15(3):537-41.

BackgroundNonaneurysmal perimesencephalic subarachnoid hemorrhage (SAH) has usually a benign prognosis and uneventful course; however, recent reports suggest that these patients may develop severe symptomatic vasospasm.MethodsDescription of the clinical course of one patient with nonaneurysmal perimesencephalic SAH who required intraarterial infusion of calcium antagonists and transluminal balloon angioplasty for treatment of symptomatic vasospasm. The perimesencephalic clot burden was quantified to determine if there is a relationship with the development of symptomatic vasospasm.ResultsDespite maximized clinical management, the patient described in this report developed vasospasm and delayed cerebral ischemia (DCI), requiring multiple endovascular interventions. The volumetric quantification of subarachnoid blood was 15.4 ml, and was mostly localized in the cisternal space.ConclusionsNonaneurysmal perimesencephalic SAH may have a "malignant" course requiring close neurocritical care monitoring and multiple clinical and endovascular interventions. Moreover, large cisternal hemorrhage was correlated with the development of DCI in this patient with non-aneurysmal SAH.

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