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Occurrence of Perimesencephalic Subarachnoid Hemorrhage During Pregnancy

Neurocritical Care volume 10, pages 339–343 (2009)Cite this article

Abstract

Background

Perimesencephalic subarachnoid hemorrhage (P-SAH) is a benign subset of subarachnoid hemorrhage with a favorable prognosis and low rate of re-bleeding. Risk factors may include hypertension and tobacco use, but it has not previously been reported during pregnancy.

Methods

We report two cases of P-SAH in pregnant women, a 40-year-old female, 8-weeks pregnant and a 37-year-old female at 35 weeks gestational age.

Results

CT scan confirmed P-SAH in both cases. CT angiography in one case and cerebral angiogram in the other did not reveal aneurysm or other potential bleeding source. The patients underwent transcranial Doppler ultrasound monitoring without evidence of vasospasm.

Conclusion

P-SAH hemorrhage may occur during early or late pregnancy. We do not propose an increased risk of P-SAH during pregnancy. The clinical course appears favorable and CT angiography alone may be considered the preferred diagnostic test to assess for aneurysm in first trimester pregnancy.

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Affiliations

  1. Department of Neurology, Johns Hopkins University School of Medicine, Meyer 8-140, 600 N. Wolfe St., Baltimore, MD, USA

    Karen G. Hirsch & Wendy C. Ziai

  2. Department of Neurology, UCLA Stroke Center, Los Angeles, CA, USA

    Michael T. Froehler

  3. Department of Neurosurgery, Johns Hopkins University School of Medicine, Meyer 8-140, 600 N. Wolfe St., Baltimore, MD, USA

    Judy Huang

  4. Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Meyer 8-140, 600 N. Wolfe St., Baltimore, MD, USA

    Wendy C. Ziai

  5. Department of Anesthesia/Critical Care Medicine, Johns Hopkins University School of Medicine, Meyer 8-140, 600 N. Wolfe St., Baltimore, MD, USA

    Wendy C. Ziai

Authors
  1. Karen G. Hirsch
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  2. Michael T. Froehler
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  3. Judy Huang
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  4. Wendy C. Ziai
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Correspondence to Wendy C. Ziai.

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Hirsch, K.G., Froehler, M.T., Huang, J. et al. Occurrence of Perimesencephalic Subarachnoid Hemorrhage During Pregnancy. Neurocrit Care 10, 339–343 (2009). https://doi.org/10.1007/s12028-009-9189-9

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  • DOI: https://doi.org/10.1007/s12028-009-9189-9

Keywords

  • Subarachnoid hemorrhage
  • Pregnancy
  • Cerebral angiography
  • Perimesencephalic hemorrhage
  • Vasospasm