{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T12:58:08Z","timestamp":1772715488448,"version":"3.50.1"},"reference-count":21,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2011,4]]},"abstract":"\nObject<\/jats:title>\nThe aim of this study was to evaluate the diagnostic value of MR imaging in perimesencephalic (PM) and nonperimesencephalic (non-PM) subarachnoid hemorrhage (SAH) of unknown origin.<\/jats:p><\/jats:sec>\n\nMethods<\/jats:title>\nThe authors conducted a retrospective review of all patients with SAH (1226 patients) in their department between January 1991 and December 2008. Included in the study were cases of spontaneous SAH diagnosed using CT scans obtained within 24 hours of the initial symptoms and initially negative digital subtraction (DS) angiograms. Patients with traumatic SAH and an unknown history were excluded from the study. Patients with initially negative DS angiograms were divided into 2 groups: Group 1, a typically PM bleeding pattern (PM SAH); and Group 2, a non-PM bleeding pattern (non-PM SAH) such as hemorrhage in the sylvian or interhemispheric fissure. Cranial MR imaging including the craniocervical region was performed within 72 hours after SAH was diagnosed in all patients in Groups 1 and 2.<\/jats:p><\/jats:sec>\n\nResults<\/jats:title>\nOne thousand sixty-eight patients underwent DS angiography, and among them were 179 (16.7%) with negative angiograms\u201447 patients (26.3%) from Group 1 and 132 patients (73.7%) from Group 2. Magnetic resonance imaging demonstrated no bleeding sources in any case (100% negative). Thirty-four patients in Group 1 and 120 patients in Group 2 underwent a second DS angiography study. Digital subtraction angiography revealed an aneurysm as the bleeding source in 1 case in Group 1 and in 13 cases in Group 2.<\/jats:p><\/jats:sec>\n\nConclusions<\/jats:title>\nMagnetic resonance imaging of the brain and craniocervical region did not produce additional benefit for the detection of a bleeding source and the therapy administered for PM SAH and non-PM SAH (100% negative). The costs of this examination exceeded the clinical value. Despite the results of this study, MR imaging should be discussed on a case-by-case basis because rare bleeding sources are periodically diagnosed in cases of non-PM SAH. A second-look DS angiogram is necessary because aneurysmal hemorrhage occasionally produces PM SAH as well as non-PM SAH. Further prospective studies are needed to verify the authors' results in the future.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2010.6.jns10310","type":"journal-article","created":{"date-parts":[[2010,7,30]],"date-time":"2010-07-30T13:19:54Z","timestamp":1280495994000},"page":"1003-1007","source":"Crossref","is-referenced-by-count":51,"title":["Diagnostic value of magnetic resonance imaging in perimesencephalic and nonperimesencephalic subarachnoid hemorrhage of unknown origin"],"prefix":"10.3171","volume":"114","author":[{"given":"Homajoun","family":"Maslehaty","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Athanassios K.","family":"Petridis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harald","family":"Barth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hubertus Maximilian","family":"Mehdorn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-jns10310","series-title":"J Neurosurg","first-page":"29","article-title":"Incidence of intracranial vascular lesions in patients with subarachnoid hemorrhage investigated by four-vessel angiography","volume":"23","author":"af Bj\u00f6rkesten","year":"1965"},{"key":"b2-jns10310","series-title":"Neurosurgery","first-page":"1040","article-title":"Yield of further diagnostic work-up of cryptogenic subarachnoid hemorrhage based on bleeding patterns on computed tomographic scans","volume":"62","author":"Andaluz","year":"2008"},{"key":"b3-jns10310","series-title":"Zentralbl Neurochir","first-page":"108","article-title":"[Perimesencephalic subarachnoid hemorrhage\u2014an independent clinical picture of non-aneurysmatic subarachnoid hemorrhage with a benign course.]","volume":"57","author":"Barth","year":"1996"},{"key":"b4-jns10310","series-title":"J Clin Neurosci","first-page":"274","article-title":"Subarachnoid haemorrhage of unknown cause: Clinical, neuroradiological and evolutive aspects","volume":"5","author":"Berdoz","year":"1998"},{"key":"b5-jns10310","series-title":"Acta Neurochir (Wien)","first-page":"409","article-title":"Long-term outcome and quality of life after nonaneurysmal subarachnoid hemorrhage","volume":"152","author":"Beseoglu","year":"2010"},{"key":"b6-jns10310","series-title":"Am J Forensic Med Pathol","first-page":"343","article-title":"Traumatic rupture of the basilar artery: report of two cases and review of the literature","volume":"21","author":"Bunai","year":"2000"},{"key":"b7-jns10310","series-title":"J Stroke Cerebrovasc Dis","first-page":"267","article-title":"Perimesencephalic subarachnoid hemorrhage: incidence, risk factors, and outcome","volume":"14","author":"Flaherty","year":"2005"},{"key":"b8-jns10310","series-title":"No To Shinkei","first-page":"489","article-title":"[Analysis of unknown cause subarachnoid hemorrhage with repeated negative angiogram.]","volume":"58","author":"Fujii","year":"2006"},{"key":"b9-jns10310","series-title":"J Neurol","first-page":"1910","article-title":"Spinal vascular malformations in non-perimesencephalic subarachnoid hemorrhage","volume":"255","author":"Germans","year":"2008"},{"key":"b10-jns10310","series-title":"J Neuroradiol","first-page":"87","article-title":"Repeated digital substraction angiography after perimesencephalic subarachnoid hemorrhage?","volume":"33","author":"Huttner","year":"2006"},{"key":"b11-jns10310","series-title":"J Clin Neurosci","first-page":"1011","article-title":"Spontaneous subarachnoid haemorrhage with negative initial angiography: a review of 143 cases","volume":"13","author":"Jung","year":"2006"},{"key":"b12-jns10310","series-title":"J Clin Neurosci","first-page":"74","article-title":"Subarachnoid hemorrhage of unknown origin and the basilar artery configuration","volume":"10","author":"Lang","year":"2003"},{"key":"b13-jns10310","series-title":"Neurosurg Rev","first-page":"27","article-title":"Subarachnoid hemorrhage of unknown origin. Longterm prognosis","volume":"15","author":"Mehdorn","year":"1992"},{"key":"b14-jns10310","series-title":"Fortschr Neurol Psychiatr","first-page":"387","article-title":"[Spontaneous perimesencephalic subarachnoid hemorrhage (PMH). A disease category with good prognosis?]","volume":"66","author":"Meisenzahl","year":"1998"},{"key":"b15-jns10310","series-title":"AJR Am J Roentgenol","first-page":"201","article-title":"Assessment of the value of MR imaging for examining patients with angiographically negative subarachnoid hemorrhage","volume":"172","author":"Rogg","year":"1999"},{"key":"b16-jns10310","series-title":"Stroke","first-page":"2572","article-title":"Pretruncal subarachnoid hemorrhage: an anatomically correct description of the perimesencephalic subarachnoid hemorrhage","volume":"28","author":"Schievink","year":"1997"},{"key":"b17-jns10310","series-title":"Neurosurgery","first-page":"433","article-title":"Perimesencephalic nonaneurysmal subarachnoid hemorrhage: review of the literature","volume":"39","author":"Schwartz","year":"1996"},{"key":"b18-jns10310","series-title":"Intensive Care Med","first-page":"172","article-title":"Fatal traumatic subarachnoid hemorrhage due to rupture of the vertebral artery","volume":"19","author":"Takahara","year":"1993"},{"key":"b19-jns10310","series-title":"Neurology","first-page":"493","article-title":"Perimesencephalic hemorrhage: a nonaneurysmal and benign form of subarachnoid hemorrhage","volume":"35","author":"van Gijn","year":"1985"},{"key":"b20-jns10310","series-title":"Stroke","first-page":"2514","article-title":"MR imaging in pretruncal nonaneurysmal subarachnoid hemorrhage: is it worthwhile?","volume":"29","author":"Wijdicks","year":"1998"},{"key":"b21-jns10310","series-title":"Neurol Med Chir (Tokyo)","first-page":"706","article-title":"Intracranial cavernous angioma manifesting as subarachnoid hemorrhage\u2014case report","volume":"33","author":"Yamamoto","year":"1993"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/114\/4\/article-p1003.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/114\/4\/article-p1003.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/114\/4\/article-p1003.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T05:33:45Z","timestamp":1679895225000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/114\/4\/article-p1003.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2011,4]]},"references-count":21,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2010.6.jns10310","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,4]]}}}