• Yuan Hong, Yuanjian Fang, Ting Chen, and Jianmin Zhang.
• Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
• World Neurosurg. 2017 Nov 1; 107: 877-880.

BackgroundPerimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSAH) is a benign form of subarachnoid hemorrhage (SAH) with a favorable prognosis. The risk of recurrent hemorrhage of this benign entity is extremely low.Case DescriptionWe describe a rare case of recurrent, spontaneous PNSAH in a 56-year-old man. This hypertensive patient suffered a recurrent episode of PNSAH 1 month after its first ictus, suggesting rebleeding can still occur in the setting of PNSAH; however, the risk is much less than that in aneurysmal SAH. No source of the hemorrhage was identified in the imaging examinations, even with the performance of a 6-vessel angiography.ConclusionsDespite the PNSAH owning benign clinical manifestations and a favorable outcome, this distinct case of recurrent PNSAH demonstrated that the risk of recurrent hemorrhage of PNSAH does exist, although it is rather low. A conservative approach with close follow-up is still warranted for PNSAH patients.Copyright © 2017 Elsevier Inc. All rights reserved.

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