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Endovascular Treatment of Severe Vasospasm in Nonaneurysmal Perimesencephalic Subarachnoid Hemorrhage

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Abstract

Background

Nonaneurysmal perimesencephalic subarachnoid hemorrhage (SAH) has usually a benign prognosis and uneventful course; however, recent reports suggest that these patients may develop severe symptomatic vasospasm.

Methods

Description of the clinical course of one patient with nonaneurysmal perimesencephalic SAH who required intraarterial infusion of calcium antagonists and transluminal balloon angioplasty for treatment of symptomatic vasospasm. The perimesencephalic clot burden was quantified to determine if there is a relationship with the development of symptomatic vasospasm.

Results

Despite maximized clinical management, the patient described in this report developed vasospasm and delayed cerebral ischemia (DCI), requiring multiple endovascular interventions. The volumetric quantification of subarachnoid blood was 15.4 ml, and was mostly localized in the cisternal space.

Conclusions

Nonaneurysmal perimesencephalic SAH may have a “malignant” course requiring close neurocritical care monitoring and multiple clinical and endovascular interventions. Moreover, large cisternal hemorrhage was correlated with the development of DCI in this patient with non-aneurysmal SAH.

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Authors and Affiliations

  1. Baptist Cardiac and Vascular Institute, 8900 N Kendall Drive, Miami, FL, 33176, USA

    Edgar A. Samaniego, Guilherme Dabus, Karel Fuentes & Italo Linfante

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  1. Edgar A. Samaniego
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  2. Guilherme Dabus
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  3. Karel Fuentes
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  4. Italo Linfante
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Correspondence to Edgar A. Samaniego.

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Samaniego, E.A., Dabus, G., Fuentes, K. et al. Endovascular Treatment of Severe Vasospasm in Nonaneurysmal Perimesencephalic Subarachnoid Hemorrhage. Neurocrit Care 15, 537–541 (2011). https://doi.org/10.1007/s12028-011-9548-1

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  • DOI: https://doi.org/10.1007/s12028-011-9548-1

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