Diffuse vasospasm after pretruncal nonaneurysmal subarachnoid hemorrhage

Pretruncal (perimesencephalic) nonaneurysmal hemorrhage is a benign form of subarachnoid hemorrhage (SAH). Angiographic changes of vasospasm are uncom mon in patients with this type of hemorrhage, and if vasospasm is present, it is mild and focal. We report two patients with pretruncal nonaneurysmal SAH who developed severe and diffuse vasospasm, expanding the clinical spec trum of this type of SAH, The first patient was a 40-year-old woman who suf fered pretruncal nonaneurysmal SAH, Angiography performed on the seventh da y post hemorrhage showed diffuse and severe vasospasm affecting both the an terior and the posterior circulation, The patient was treated with hypervol emia, and she remained asymptomatic. Follow-up angiography showed resolutio n of the vasospasm. The second patient was a 67-year-old woman who suffered pretruncal nonaneurysmal SAH, The results of the initial angiography were normal. Repeat angiography on the ninth day post hemorrhage showed severe v asospasm in the anterior circulation and moderate vasospasm in the posterio r circulation. Nine hours later, the patient developed transient dysphasia, and she was treated with hypervolemia, Three days later, a transcranial Do ppler examination showed normalization of blood velocities. The presence of diffuse and severe vasospasm does not exclude a diagnosis of pretruncal no naneurysmal SAH.