National Journal of Emergency Medicine SEMI

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 1 , ISSUE 2 ( May-August, 2023 ) > List of Articles


A Rare Case of Anterior Communicating Artery Aneurysm Rupture Presenting as Perimesencephalic Subarachnoid Haemorrhage

Renaldo Pavrey, Vikrant Chouhan, Aakanksha Goyal

Keywords : ACom aneurysm, Case report, Perimesencephalic, Subarachnoid haemorrhage

Citation Information : Pavrey R, Chouhan V, Goyal A. A Rare Case of Anterior Communicating Artery Aneurysm Rupture Presenting as Perimesencephalic Subarachnoid Haemorrhage. 2023; 1 (2):52-55.

DOI: 10.5005/njem-11015-0012

License: CC BY-NC 4.0

Published Online: 05-12-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Perimesencephalic subarachnoid haemorrhage (PMSAH) is a distinct pattern of non-aneurysmal subarachnoid haemorrhage (SAH) centred on the basal cisterns around the midbrain. It is rare, with an incidence of 0.5 in 1,00,000 adults. Also, PMSAH represents 5–10% of all SAHs and nearly 33% of all non-aneurysmal SAH. While 95% of PMSAH are non-aneurysmal, 5% of cases are due to a vertebrobasilar aneurysm. We present the case of a 59-year-old female with PMSAH in whom the source of the bleeding was localised to a ruptured anterior communicating artery (ACom) aneurysm. In our report, we highlight the characteristic neuroimaging findings of PMSAH, the importance of digital subtraction angiography (DSA), and the necessity for an interdisciplinary approach in the management of such cases. Our reason for highlighting this case is that PMSAH is a rare cause of non-traumatic, predominantly non-aneurysmal SAH. In the setting of a ruptured ACom artery aneurysm, we believe the uniqueness of this case gets elevated.

  1. Flaherty ML, Haverbusch M, Kissela B, et al. Perimesencephalic subarachnoid hemorrhage: Incidence, risk factors, and outcome. J Stroke Cerebrovasc Dis 2005;14(6):267–271. DOI: 10.1016/j.jstrokecerebrovasdis.2005.07.004.
  2. Marder CP, Narla V, Fink JR, et al. Subarachnoid haemorrhage: Beyond aneurysms. AJR Am J Roentgenol 2014;202(1):25–37. DOI: 10.2214/AJR.12.9749.
  3. van der Schaaf IC, Velthuis BK, Gouw A, et al. Venous drainage in perimesencephalic hemorrhage. Stroke 2004;35(7):1614–1618. DOI: 10.1161/01.STR.0000131657.08655.ce.
  4. van Gijn J, van Dongen KJ, Vermeulen M, et al. Perimesencephalic haemorrhage: A non-aneurysmal and benign form of subarachnoid haemorrhage. Neurology 1985;35(4):493–497. DOI: 10.1212/wnl.35.4.493.
  5. Schwartz TH, Mayer SA. Quadrigeminal variant of perimesencephalic nonaneurysmal subarachnoid haemorrhage. Neurosurgery 2000; 46:584–588. DOI: 10.1097/00006123-200003000-00012.
  6. Şahin S, Delen E, Korfali E. Perimesencephalic subarachnoid hemorrhage: Etiologies, risk factors, and necessity of the second angiogram. Asian J Neurosurg 2016;11(1):50–53. DOI: 10.4103/1793-5482.165793.
  7. Schwartz TH, Solomon RA. Perimesencephalic nonaneurysmal subarachnoid hemorrhage: Review of the literature. Neurosurgery 1996;39(3):433–440. DOI: 10.1097/00006123-199609000-00001.
  8. Larson AS, Brinjikji W. Subarachnoid haemorrhage of unknown cause: Distribution and role of imaging. Neuroimaging Clin N Am 2021:31(2):167–175. DOI: 10.1016/j.nic.2021.01.001.
  9. Backes D, Rinkel GJ, Kemperman H, et al. Time-dependent test characteristics of head computed tomography in patients suspected of nontraumatic subarachnoid haemorrhage. Stroke 2012;43(8): 2115–2119. DOI: 10.1161/STROKEAHA.112.658880.
  10. Kapadia A, Schweizer TA, Spears J, et al. Nonaneurysmal perimesencephalic subarachnoid hemorrhage: Diagnosis, pathophysiology, clinical characteristics, and long-term outcome. World Neurosurg 2014;82(6):1131–1143. DOI: 10.1016/j.wneu.2014.07.006.
  11. Potter CA, Fink KR, Ginn AL, et al. Perimesencephalic hemorrhage: Yield of single versus multiple DSA examinations—A single-center study and meta-analysis. Radiology 2016;281(3):858–864. DOI: 10.1148/radiol.2016152402.
  12. Mensing LA, Vergouwen MDI, Laban KG, et al. Perimesencephalic haemorrhage: A review of epidemiology, risk factors, presumed cause, clinical course, and outcome. Stroke 2018;49(6):1363–1370. DOI: 10.1161/STROKEAHA.117.019843.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.