Objective
To review the diagnostic evaluation and the clinical course of patients with pretruncal
nonaneurysmal subarachnoid hemorrhage.
Material and Methods
The study population consisted of a consecutive series of patients with a pretruncal
nonaneurysmal subarachnoid hemorrhage encountered at Mayo Clinic Rochester during
a 6-year interval. We reviewed the clinical manifestations, the neuroimaging characteristics,
and the appropriate management.
Results
The 15 male and 9 female patients with a pretruncal nonaneurysmal subarachnoid hemorrhage
ranged from 3 to 72 years of age (median, 45). Of the 24 patients, 18 had a sudden
explosive headache at the time of initial assessment. Ventricular shunting for acute
hydrocephalus was indicated in one patient. Neuroimaging studies demonstrated that
the center of the hemorrhage was prepontine, and it extended into the inter-peduncular
or pre medullary cisterns. In two patients, a small focal hemorrhage was not noted
on an admission computed tomographic scan but was identified on repeated study. A
second four-vessel cerebral angiogram, obtained in most patients, showed normal findings
in four patients who had had cerebral vasospasm on the first study. In one patient,
moderate cerebral vasospasm was found on the second angiogram. No patient had rebleeding.
One patient had transient dysphasia associated with cerebral vasospasm after cerebral
angiography. Two patients had a family history of aneurysmal subarachnoid hemorrhage.
Conclusion
The excellent outcome in patients with pretruncal nonaneurysmal subarachnoid hemorrhage
is in distinct contrast to the overall somber outcome associated with aneurysmal subarachnoid
hemorrhage. A ruptured aneurysm of the posterior circulation may mimic a pretruncal
nonaneurysmal subarachnoid hemorrhage and should be excluded on the basis of a technically
satisfactory cerebral angiogram.
Abbreviations:
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© 1998 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
