Perimesencephalic Subarachnoid Hemorrhage Bleeding Patterns Are Not Always Benign: Prognostic Impact of an Aneurysmal Pathology
<b>Background/Objectives</b>: Perimesencephalic subarachnoid hemorrhage (pmSAH) is generally considered to be a benign variant of spontaneous SAH. However, in rare cases, an underlying aneurysm may be present, altering both clinical management and prognosis. The aim of this study was to...
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2025-06-01
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| author | Emily Hoffmann Công Dùy Bui David Ventura Manfred Musigmann Alexandra Valls Chavarria Markus Holling Vivek S. Yedavalli Jeremy J. Heit Christian Paul Stracke Tobias D. Faizy Hermann Krähling Burak Han Akkurt |
| author_facet | Emily Hoffmann Công Dùy Bui David Ventura Manfred Musigmann Alexandra Valls Chavarria Markus Holling Vivek S. Yedavalli Jeremy J. Heit Christian Paul Stracke Tobias D. Faizy Hermann Krähling Burak Han Akkurt |
| author_sort | Emily Hoffmann |
| collection | DOAJ |
| description | <b>Background/Objectives</b>: Perimesencephalic subarachnoid hemorrhage (pmSAH) is generally considered to be a benign variant of spontaneous SAH. However, in rare cases, an underlying aneurysm may be present, altering both clinical management and prognosis. The aim of this study was to evaluate the prognostic impact of aneurysmal pathology in patients presenting with perimesencephalic hemorrhage, focusing on the occurrence of complications and functional outcomes. <b>Methods</b>: This single-center, retrospective study included 77 patients diagnosed with perimesencephalic hemorrhage between 2012 and 2022. Clinical and radiological data were extracted, including demographics, risk factors, complications (hydrocephalus, vasospasm, and delayed cerebral ischemia (DCI)), and outcome scores (Glasgow Outcome Scale (GOS) and modified Rankin scale (mRS) at discharge). Patients were divided into two groups based on the presence or absence of an aneurysm confirmed through digital subtraction angiography (DSA). <b>Results</b>: Of the 77 patients, 7 (9.1%) were found to have an aneurysm. While rates of complications such as hydrocephalus and DCI were higher in the aneurysm group, these differences did not reach statistical significance. However, patients with aneurysms had significantly worse functional outcomes, with higher mRS and lower GOS scores at discharge. Logistic regression confirmed the presence of aneurysms as an independent factor associated with poor outcomes (OR = 21.6; 95% CI: 1.00−467.3; <i>p</i> = 0.050), while other variables such as age, sex, and World Federation of Neurosurgical Societies (WFNS) score were not statistically significant. ROC analysis showed moderate discriminative power of aneurysm presence for poor outcomes (AUC = 0.72). <b>Conclusions</b>: The presence of an aneurysm, although rare in pmSAH, significantly worsens functional outcomes. These findings highlight the necessity of early and sensitive vascular diagnostics—particularly DSA—to reliably exclude aneurysms. Differentiating between aneurysmal and non-aneurysmal perimesencephalic bleeding is essential not only for clinical decision-making but also for optimizing resource allocation in neurocritical care. |
| format | Article |
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| institution | Kabale University |
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| spelling | doaj-art-48e1c0fb704b49ecbb540bd642dc91432025-08-20T03:26:21ZengMDPI AGBiomedicines2227-90592025-06-01136144410.3390/biomedicines13061444Perimesencephalic Subarachnoid Hemorrhage Bleeding Patterns Are Not Always Benign: Prognostic Impact of an Aneurysmal PathologyEmily Hoffmann0Công Dùy Bui1David Ventura2Manfred Musigmann3Alexandra Valls Chavarria4Markus Holling5Vivek S. Yedavalli6Jeremy J. Heit7Christian Paul Stracke8Tobias D. Faizy9Hermann Krähling10Burak Han Akkurt11Clinic of Radiology, University of Münster, 48149 Münster, GermanyClinic of Radiology, University of Münster, 48149 Münster, GermanyDepartment of Nuclear Medicine, University of Münster, 48149 Münster, GermanyClinic of Radiology, University of Münster, 48149 Münster, GermanyDepartment of Neurosurgery, University of Münster, 48149 Münster, GermanyDepartment of Neurosurgery, University of Münster, 48149 Münster, GermanyRussell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD 21287, USADepartment of Neuroradiology, Stanford University, Stanford, CA 94304, USADivision of Interventional Neuroradiology, University of Münster, 48149 Münster, GermanyDivision of Interventional Neuroradiology, University of Münster, 48149 Münster, GermanyDivision of Interventional Neuroradiology, University of Münster, 48149 Münster, GermanyClinic of Radiology, University of Münster, 48149 Münster, Germany<b>Background/Objectives</b>: Perimesencephalic subarachnoid hemorrhage (pmSAH) is generally considered to be a benign variant of spontaneous SAH. However, in rare cases, an underlying aneurysm may be present, altering both clinical management and prognosis. The aim of this study was to evaluate the prognostic impact of aneurysmal pathology in patients presenting with perimesencephalic hemorrhage, focusing on the occurrence of complications and functional outcomes. <b>Methods</b>: This single-center, retrospective study included 77 patients diagnosed with perimesencephalic hemorrhage between 2012 and 2022. Clinical and radiological data were extracted, including demographics, risk factors, complications (hydrocephalus, vasospasm, and delayed cerebral ischemia (DCI)), and outcome scores (Glasgow Outcome Scale (GOS) and modified Rankin scale (mRS) at discharge). Patients were divided into two groups based on the presence or absence of an aneurysm confirmed through digital subtraction angiography (DSA). <b>Results</b>: Of the 77 patients, 7 (9.1%) were found to have an aneurysm. While rates of complications such as hydrocephalus and DCI were higher in the aneurysm group, these differences did not reach statistical significance. However, patients with aneurysms had significantly worse functional outcomes, with higher mRS and lower GOS scores at discharge. Logistic regression confirmed the presence of aneurysms as an independent factor associated with poor outcomes (OR = 21.6; 95% CI: 1.00−467.3; <i>p</i> = 0.050), while other variables such as age, sex, and World Federation of Neurosurgical Societies (WFNS) score were not statistically significant. ROC analysis showed moderate discriminative power of aneurysm presence for poor outcomes (AUC = 0.72). <b>Conclusions</b>: The presence of an aneurysm, although rare in pmSAH, significantly worsens functional outcomes. These findings highlight the necessity of early and sensitive vascular diagnostics—particularly DSA—to reliably exclude aneurysms. Differentiating between aneurysmal and non-aneurysmal perimesencephalic bleeding is essential not only for clinical decision-making but also for optimizing resource allocation in neurocritical care.https://www.mdpi.com/2227-9059/13/6/1444perimesencephalic subarachnoid hemorrhageaneurysmoutcomehydrocephalusvasospasmdelayed cerebral ischemia |
| spellingShingle | Emily Hoffmann Công Dùy Bui David Ventura Manfred Musigmann Alexandra Valls Chavarria Markus Holling Vivek S. Yedavalli Jeremy J. Heit Christian Paul Stracke Tobias D. Faizy Hermann Krähling Burak Han Akkurt Perimesencephalic Subarachnoid Hemorrhage Bleeding Patterns Are Not Always Benign: Prognostic Impact of an Aneurysmal Pathology Biomedicines perimesencephalic subarachnoid hemorrhage aneurysm outcome hydrocephalus vasospasm delayed cerebral ischemia |
| title | Perimesencephalic Subarachnoid Hemorrhage Bleeding Patterns Are Not Always Benign: Prognostic Impact of an Aneurysmal Pathology |
| title_full | Perimesencephalic Subarachnoid Hemorrhage Bleeding Patterns Are Not Always Benign: Prognostic Impact of an Aneurysmal Pathology |
| title_fullStr | Perimesencephalic Subarachnoid Hemorrhage Bleeding Patterns Are Not Always Benign: Prognostic Impact of an Aneurysmal Pathology |
| title_full_unstemmed | Perimesencephalic Subarachnoid Hemorrhage Bleeding Patterns Are Not Always Benign: Prognostic Impact of an Aneurysmal Pathology |
| title_short | Perimesencephalic Subarachnoid Hemorrhage Bleeding Patterns Are Not Always Benign: Prognostic Impact of an Aneurysmal Pathology |
| title_sort | perimesencephalic subarachnoid hemorrhage bleeding patterns are not always benign prognostic impact of an aneurysmal pathology |
| topic | perimesencephalic subarachnoid hemorrhage aneurysm outcome hydrocephalus vasospasm delayed cerebral ischemia |
| url | https://www.mdpi.com/2227-9059/13/6/1444 |
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