title: Recurrent perimesencephalic subarachnoid hemorrhage during antithrombotic therapy.
abstract: BACKGROUND
  In patients with non-aneurysmal perimesencephalic hemorrhage, spontaneous rebleeding does not occur. The lack of reported recurrences may lead to less cautious administration of antithrombotic therapy.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  A 57-year-old woman with a perimesencephalic pattern of hemorrhage and negative CT angiography was treated with carbasalate calcium and intravenous heparin because of an acute coronary syndrome. Three days after installment of this antithrombotic therapy she experienced a recurrent perimesencephalic hemorrhage leading to hydrocephalus and a decrease in consciousness. She died the same day as a result of ventricular fibrillation.
  
  
  CONCLUSIONS
  In the early phase after perimesencephalic hemorrhage, anticoagulant therapy may lead to rebleeding. The risks and benefits of antithrombotic therapy should be carefully weighed in patients with a perimesencephalic pattern of hemorrhage and negative CT angiography.
authors.affiliation: Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Heidelberglaan 100, 3584 Utrecht, The Netherlands. h.b.vanderworp@umcutrecht.nl
authors.forename: H Bart
authors.initials: HB
authors.lastname: van der Worp
authors.forename: Susanne
authors.initials: S
authors.lastname: Fonville
authors.forename: Lino M P
authors.initials: LM
authors.lastname: Ramos
authors.forename: Gabriël J E
authors.initials: GJ
authors.lastname: Rinkel
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects*; D002533:Cerebral Angiography; D017809:Fatal Outcome; D005260:Female; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008636:Mesencephalon / Q000098:blood supply; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000188:drug therapy; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D012008:Recurrence; D013345:Subarachnoid Hemorrhage / Q000139:chemically induced* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D006493:Heparin; D001241:Aspirin