title: Endovascular treatment of severe vasospasm in nonaneurysmal perimesencephalic subarachnoid hemorrhage.
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.
authors.affiliation: Baptist Cardiac and Vascular Institute, 8900 N Kendall Drive, Miami, FL 33176, USA. edgarsama@gmail.com
authors.forename: Edgar A
authors.initials: EA
authors.lastname: Samaniego
authors.forename: Guilherme
authors.initials: G
authors.lastname: Dabus
authors.forename: Karel
authors.initials: K
authors.lastname: Fuentes
authors.forename: Italo
authors.initials: I
authors.lastname: Linfante
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon; D001783:Blood Flow Velocity / Q000187:drug effects / Q000502:physiology; D002121:Calcium Channel Blockers / Q000008:administration & dosage*; D002533:Cerebral Angiography; D002946:Cisterna Magna / Q000098:blood supply; D003131:Combined Modality Therapy; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007261:Infusions, Intra-Arterial; D018810:Magnetic Resonance Angiography; D008297:Male; D008636:Mesencephalon / Q000098:blood supply; D009553:Nimodipine / Q000008:administration & dosage*; D013345:Subarachnoid Hemorrhage / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D020301:Vasospasm, Intracranial / Q000628:therapy*
chemical_list: D002121:Calcium Channel Blockers; D009553:Nimodipine