Article

Perimesencephalic subarachnoid hemorrhage: incidence, risk factors, and outcome.

{ "0" : "Department of Neurology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA" , "1" : "Department of Environment Health, University of Cincinnati Medical Center, Cincinnati, Ohio, USA" , "3" : "Perimesencephalic subarachnoid hemorrhage" , "4" : "subarachnoid hemorrhage" , "5" : "epidemiology" , "6" : "risk factors"}
Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 14(6):267-71. DOI:10.1016/j.jstrokecerebrovasdis.2005.07.004
Source: PubMed

ABSTRACT Nonaneurysmal perimesencephalic subarachnoid hemorrhage (PMSAH) appears to have an etiology and natural history distinct from aneurysm rupture. Referral-based studies suggest that 15% of SAH patients have no discernable cause of bleeding, but the incidence of PMSAH is unknown. We describe the first population-based study of PMSAH and place it in the context of all non-traumatic SAH, with presentation of incidence rates, patient demographics, and clinical outcomes.
All patients age >/= 18 hospitalized with first-ever, non-traumatic SAH in the Greater Cincinnati area were identified from 5/98-7/01 and 8/02-4/04. PMSAH was defined as hemorrhage restricted to the cisterns surrounding the brainstem and suprasellar cistern and a negative cerebral angiogram. Incidence rates were age, race, and sex adjusted to the 2000 US population.
There were 431 SAHs identified. Cases in Asian-Americans (2) were excluded, leaving 429 SAHs for analysis. Of these patients, 77 did not have angiograms. Among remaining cases, 285 had aneurysm rupture, 43 had nonaneurysmal hemorrhage not of the PMSAH pattern, and 24 had PMSAH. The overall annual incidence rates for SAH and PMSAH were 8.7 (95% CI 7.9-9.5) and 0.5 (95% CI 0.3-0.7) per 100,000 persons age >/= 18. Patients with PMSAH were younger (p = 0.018) and less likely to be female (p = 0.020) or hypertensive (p = 0.005) than other SAH patients. There was one death among PMSAH patients during 14 months mean follow-up.
PMSAH represents approximately 5% of all SAH. Its risk factors and outcome differ from other forms of SAH.

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Keywords

aneurysm rupture
 
brainstem
 
Cases
 
cisterns
 
clinical outcomes
 
etiology
 
first population-based study
 
first-ever
 
Greater Cincinnati area
 
natural history distinct
 
negative cerebral angiogram
 
non-traumatic SAH
 
Nonaneurysmal perimesencephalic subarachnoid hemorrhage
 
Patients
 
PMSAH patients
 
PMSAH pattern
 
Referral-based studies
 
risk factors
 
SAH patients
 
suprasellar cistern