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- Perimesencephalic subarachnoid haemorrhage
- posterior cerebral artery
- intracranial aneurysm
- subarachnoid haemorrhage
Perimesencephalic subarachnoid haemorrhage is a distinct radiographic and clinical entity of uncertain aetiology. This syndrome is diagnosed by the characteristic pattern of extravasated blood on brain CT in combination with a negative cerebral angiography.1 Current practice requires digital subtraction angiography (DSA) to exclude an aneurysm in patients with a perimesencephalic pattern of subarachnoid haemorrhage (SAH). Although up to 96% of patients with this pattern of SAH do not have an aneurysm, and will undergo an uneventful clinical course with invariably good outcome,1 about 4% of patients might have a vertebrobasilar aneurysm requiring emergent treatment.1
We present a patient with a perimesencephalic pattern of SAH caused by rupture of dissecting posterior cerebral artery (PCA) aneurysm. To our knowledge, this is the first reported case of perimesencephalic pattern of SAH caused by a dissecting aneurysm in such a location.
A 62-year-old man presented at the emergency department because of severe headache, nausea and vomiting. The headache, initially located on the right fronto-temporal side, had developed over the course of a few minutes, while …