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The difference? NASAH vs Perimesencephalic

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I am hoping and thinking someone on here (BTG) can answer a question and help me understand. I had a NASAH. What it the difference between

non aneurysmal subarachnoid hemorrhage 
perimesencephalic hemorrhage
I am not good on the computer like I used to be, I cannot search like before. I also have a VERY hard time comprehending. So any help is appreciated.
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Hey!  I can answer this one.  The perimesencephalic hemorrhage is one where there is blood only in a particular part of the brain.   Now technically it is a nonaneurysmic one as well. 

Perimesencephalic NASAH is characterized by a distinctive pattern of blood seen on an initial CT scan performed within hours of symptom onset. The subarachnoid blood is confined to the midbrain cisterns, with no evidence of intraventricular or intracerebral hemorrhage (Fig 1).


Source: http://www.medscape.com/viewarticle/559142_4

(BTG Admin Edit re: Copyrighted Material)



 These have the best outcomes.


Then there are the nonaneurysmic ones that bleed outside of this perimesencephalic part of the brain or in a different part altogether.  They are suspicious in these that there may actually be an aneurysm that they can't see or went away...


My husbands was mainly perimesencephalic but has a little bit of bleed into another area as well.


Clear as mud?

Edited by Karen
Copyrighted material/Source has been added. Please refer to forum rule 6
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Hey Eliz,


I am exactly like your husband.  Mostly peri, but some outside of area.  My neurosurgeon called me diffuse, but everyone else labeled me as Peri.  I needed no surgery either because they couldn't find anything to fix on either angiograms or the mri I had done.  Followup is none needed for ever.  It seemed so strange at the time because I did have a bunch of recovering to do from moving to emotional to thought patterns.  


However, I am in a really great place now and I am aware that many people who have SAH are far worse off than I.  I've also met several other people with NASAH who had their bleed in other completely different areas and their deficits are what you would expect when you find out which area.


 I just had no idea what the final filtering of the brain-stem really could mean.  Everyone is interested in the cortex for some reason in neuroscience and I was no different.  Our animal part really does a lot and affects all areas of existence because everything that goes out or in goes through the brain stem.


Some connections in other parts of the cortex are just local or they only affect one area of life ie: speech or movement.  Of course someone with one of these deficits really is at a loss, but losing function in multiple areas all at once...that sucked.  I am lucky in that most of my deficits have cleared up one after another.  I'm still doing some clearing, but I'm well on my way.


If your husband is able to work now, he will only improve his stamina in the following years.  I hope that his colleges can understand that it just takes time and you can't change this no matter what you do.  Time never cares what you want.



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Liz- I can't thank you enough for putting the definition in plain english that I could understand very easily!!! Knowing that makes me understand what I had was clearly a NASAH because I asked my nuerologist recently where my bleed was and she confirmed exactly what my neurosurgeon told me- and that was my bleed was all over my brain- not in just one or two areas but the entire brain.  I didn't understand it when they told me, until I read your description. Thank you VERY much!!!


Kris- I have problems in many areas- from long and short term memory, asphia (speaking problems), getting lost (driving)- so I don't drive by myself anymore, I can't use computers- like I used to, no comprending, I have a really hard time looking at something - like on a  piece of paper and then copy it onto another piece of paper (not sure if that is clear), my vision has really been affected, and there is other stuff but this is what I can think of right now.


I'm not sure if this makes a difference as far as receovery or what parts of the brain are affected- but the blood that was in my brain area was making my brain swell (or something like that- I'm not really sure) so the doc had to drill a hole in my skull to drain the excess blood out. and there was a lot of it!! I have no memory of my time in ICU or for months before or after my bleed. 


Thank you for your input,


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Ponigirl. The hole you had was possibly an extra ventricular drain I think. EVD . I had one also. The reason for the procedure was explained to me some months afterwards by my neuro team as this: When the bleed leaks over the brain in a SAH it can prevent or block the absorption of the cerebral spinal fluid by the ventricles, this combination build up of fluid and pressure is incredibly dangerous ( as if the bleed isn't already !!)


Basically its a double whammy brain crisis and the pressure ( hydrocephalus) requires immediate attention because in itself causes damage through pressure all over the delicate brain surface. I had to have the EVD placed before they would even attempt coiling. Allegedly the EVD procedure is one of trickiest brain surgeons perform because of where they have to place the tubing through but they all sound pretty risky to me.


Anyway the basic facts are blood where it shouldn't be and then building pressure of fluid on the brain which is literally a time bomb. The EVD allows the csf pressure to reduce and be managed with the hope the ventricles can resume working once the blood disperses , which it does for many.


In some cases though the ventricles are found too be badly damaged to work and the hydrocephalus remains a permanent condition as legacy from the SAH and this brings with it admission to the VP shunt club for some of us with a permanent valve and drain to manage Fluid pressure.


I found I needed to know exactly why and how this tubing etc in my head works and why it was neccesary and that helps me so just sharing what I learnt,.

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