Midbrain Stroke With Angiogram-Negative Subarachnoid Hemorrhage Mimicking a Perimesencephalic Bleed

摘要

Angiogram-negative atraumatic subarachnoid hemorrhage (SAH) in a perimesen-cephalic pattern on computed tomography (CT) is associated with an almost invariably favorable prognosis with few rebleeds. We report a patient who exhibited a perimesencephalic hemorrhage pattern on CT and negative serial angio-grams and who presented with severe neurologic disability from a concurrent midbrain stroke. We contend that both the acute infarction and hemorrhage arose from obliteration of a penetrating end artery. Possible etiologies of angiogram-negative SAH, including perimesencephalic hemorrhage, are discussed.