Tigran Petrosyan, MD, Georgios Mantziaris, MD, Georgios Arealis, MD, Eftychios Archontakis, MD, *Stylianos Pikis, MD, MSc


Perimesencephalic subarachnoid hemorrhage is a variant of subarachnoid hemorrhage of unknown etiology and generally good prognosis. In-hospital rebleeding is an extremely rare but potentially lethal complication of perimesencephalic subarachnoid hemorrhage. We report on a 77-year-old female with a history of hypertension and anticoagulant use due to atrial fibrillation who was admitted to the Neurosurgery department due to World Federation of Neurological Surgeons Grade I subarachnoid hemorrhage. Head, Non Contrast Computerized Tomography (NCCT) scan revealed a perimesencephalic bleeding pattern. Cerebral Magnetic Resonance (MR) Imaging and MR Angiography did not reveal any abnormalities. Within hours of admission, the patient experienced rapid neurologic deterioration and was intubated. Repeat head NCCT scan demonstrated rebleeding. Cerebral Digital Substraction Angiography revealed active contrast extravasation from the right Anterior Inferior Cerebellar Artery. Glubran embolization was performed and an external ventricular drain was then placed. However, the patient succumbed to her disease two weeks later. Early rebleeding is an extremely rare, but potentially lethal complication of perimesencephalic subarachnoid hemorrhage. Development of new neurologic symptoms should alert the physician about the possibility of rebleeding. Moreover, patients and their families should be informed about the very low probability of rebleeding and poor outcome.

Keywords: Perimesencephalic; Subarachnoid hemorrhage; Rebleeding; In-hospital.

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