Case report| Volume 14, ISSUE 3, P136-137, May 2005

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

      Angiogram-negative atraumatic subarachnoid hemorrhage (SAH) in a perimesencephalic 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 angiograms 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.

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