Perimesencephalic subarachnoid haemorrhage (pmSAH)

Written and reviewed by Dr Ibrahim Imam, Consultant Neurologist. Last reviewed .

Perimesencephalic subarachnoid haemorrhage (pmSAH). This is subarachnoid haemorrhage with bleeding located anterior to the midbrain.

Diagnostic features

  • This is subarachnoid haemorrhage with bleeding located anterior to the midbrain
  • There is no associated intraparenchymal or intraventricular extension
  • There is no source of bleeding identified on 4-vessel angiography
  • The course is usually benign with a good outcome

Clinical features

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Causes

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Complications: re-bleeding

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Complications: others

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Investigations

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References

  1. Mensing LA, Vergouwen MDI, Laban KG, et al. Perimesencephalic hemorrhage: a review of epidemiology, risk factors, presumed cause, clinical course, and outcome. Stroke 2018; 49:1363-1370.
  2. Pita Lobo P, Campos J, Neto L, Canhao P. Posterior cerebral artery dissecting aneurysm: another causer of perimesencephalic postern of subarachnoid hemorrhage. JNNP 2010; 82:584-585.
  3. van der Schaaf I, Velthuis BK, Gouw A, Rinkel GJE. Venous drainage in perimesencephalic hemorrhage. Stroke 2004; 35:1614-1618.
  4. Rouchaud A, Lehman VT, Murad MH, et al. Nonaneurysmal perimesencephalic hemorrhage is associated with deep cerebral venous drainage anomalies: a systematic literature review and meta-analysis. Am J Neuroradiol 2016; 37:1657-1663. 
  5. Fu FW, Rao J, Zheng YY, et al. Perimesencephalic nonaneurysmal subarachnoid hemorrhage caused by transverse sinus thrombosis: A case report and review of literature. Medicine (Baltimore) 2017; 96(33):e7374. 
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