Recurrent Perimesencephalic Subarachnoid Hemorrhage After 12 Years: Missed Diagnosis, Vulnerable Anatomy, or Random Events?

摘要: Background Perimesencephalic subarachnoid hemorrhage (PMSAH) is a well-defined subtype of angiogram-negative SAH, characterized by benign natural history and virtually nonexistent risk recurrence. Few case reports recurrent PMSAH exist in the literature, all occurring after relatively short time intervals ranging from 5 days to 31 months, mostly patients on antithrombotic therapy. We present unique ultra-late recurrence 12 years, patient not receiving medications. Case Description A woman presented with 2 similar episodes sudden-onset severe headache neck pain, without associated neurologic deficits: first episode at age 48 years second 60 years. In each instance, pattern was consistent PMSAH, platelet count coagulation tests were normal, full etiologic work-up, including CTA, catheter angiography, magnetic resonance imaging, failed reveal an underlying vascular or tumoral etiology. The had favorable clinical course time. Conclusions Although exceptional, impossible. If events are assumed be random independent other, binomial statistics yield approximately 79 per billion chance more over 80-year lifetime. However, other possibilities should kept mind, tiny radiographically occult lesions particular venous anatomy predisposing bouts PMSAH. Patients told that zero, but it close zero.