Nonaneurysmal Subarachnoid Hemorrhage : Rare Complication of Vertebroplasty

On rare occasions, percutaneous vertebroplasty (PV) may be associated with adverse spinal and extraspinal events. Subarachnoid hemorrhage (SAH) has not been reported complication following a PV. This is a report of two elderly women with spine compressions who developed idiopathic SAH after injecting polymethylmethacrylate into the thoracolumbar region transcutaneously. PV was performed as an usual manner on prone position under local anesthesia for these patients. During the interventions, two patients complained of a bursting nature of headache and their arterial blood pressure was jumped up. Computed tomography scans revealed symmetric SAH on the both hemispheres and moderate degree of hydrocephalus. Any intracranial vascular abnormalities for their SAH were not evident on modern neuroangiography modalities. One patient received a ventricular shunt surgery, but both fully recovered from the procedure-related SAH. The pathophysiologic mechanism that induce SAH will be discussed, with suggesting the manner that prevent and minimize this rare intracranial complication after PV.

Frequency of Aneurysmal Subarachnoid Hemorrhage in Perimesencephalic Subarachnoid Hemorrhage and Need of 4-vessel Angiography

OBJECTIVE: In this study, each of the frequency of nonaneurysmal perimesencephalic subarachnoid hemorrhage(N-PMSH), and the clinical and radiologic features, incidence and location of aneurysmal perimesencephalic subarachnoid hemorrhage(A-PMSH), based on aneurysmal rupture and nonaneurysmal subarachnoid hemorrhage in patients with spontaneous subarachnoid hemorrhage, are investigated for clinical application. METHODS: Patients who showed perimesencephalic subarachnoid hemorrhage, among the 388 patients with subarachnoid hemorrhage admitted into the our hospital from March 1994 to November 2002, were extracted ; and their charts and angiographies were examined retrospectively. They were divided into two groups - aneurysmal perimesencephalic subarachnoid hemorrhage group and nonaneurysmal perimesencephalic subarachnoid hemorrhage group - and comparative analysis was conducted on the clinical patterns and radiologic characteristics of each group. RESULTS: There were 22 patients(5.68%) with perimesencephalic subarachnoid hemorrhage(PMSH) among 388 patients with spontaneous subarachnoid hemorrhage. Of the 22 PMSH, 8 patients(36%) were aneurysmal PMSH(A-PMSH), 14 patients(64%) were nonaneurysmal PMSH(N-PMSH). N-PMSH occurred not only in the posterior circulation(5 cases), but also in the anterior circulation(3 cases). There was no difference in the CT features of PMSH between aneurysmal and nonaneurysmal cause. CONCLUSION: According to the above results, 4-vessel angiography is essential for patients with perimesencephalic subarachnoid hemorrhage, and CTA and MRA can be used as assisting diagnosis methods.