Comment on Roman-Filip et al. Non-Aneurysmal Perimesencephalic Subarachnoid Hemorrhage: A Literature Review. Diagnostics 2023, 13, 1195
Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06501, USA
Diagnostics 2023, 13(22), 3463; https://doi.org/10.3390/diagnostics13223463
Submission received: 23 July 2023
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Accepted: 15 November 2023
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Published: 17 November 2023
(This article belongs to the Special Issue Imaging of the Brain and Blood Vessels in Ischemic Stroke)
We would like to congratulate Roman-Filip et al. on their recent review on perimesencephalic hemorrhages [1]. We have a few comments about the diagnostic approach to perimesencephalic hemorrhages.
Noncontrast CT has been shown to have very high sensitivity and negative predictive value for subarachnoid hemorrhages in the first 6 h of the onset of a thunderclap headache [2]. Although CTA is being increasingly used by emergency physicians due to the ease of ordering and the shorter associated ED stay, it is important to keep in mind that CTA is detecting aneurysms and not intracranial bleeds [3,4]. Lumbar punctures may be more appropriate for the detection of subarachnoid hemorrhages [5]. The detection of incidental aneurysms leads to a dilemma, and CTA is not cost-effective in looking for subarachnoid hemorrhages in patients with thunderclap headaches [6,7,8].
A small proportion of perimesencephalic hemorrhages are caused by posterior circulation aneurysms. However, there is limited utility for any further imaging after a negative CTA in patients with perimesencephalic hemorrhages [9]. Further imaging may not be cost-effective given its low-utility [10,11,12]. However, the use of repeat imaging remains prevalent, and the previous literature seems to have had limited impact on actual clinical practice [13].
Recurrence is rare, and prognosis in perimesencephalic hemorrhages is relatively better compared to aneurysmal subarachnoid hemorrhages [14].
Conflicts of Interest
The author declares no conflict of interest.
References
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Malhotra, A. Comment on Roman-Filip et al. Non-Aneurysmal Perimesencephalic Subarachnoid Hemorrhage: A Literature Review. Diagnostics 2023, 13, 1195. Diagnostics 2023, 13, 3463. https://doi.org/10.3390/diagnostics13223463
AMA Style
Malhotra A. Comment on Roman-Filip et al. Non-Aneurysmal Perimesencephalic Subarachnoid Hemorrhage: A Literature Review. Diagnostics 2023, 13, 1195. Diagnostics. 2023; 13(22):3463. https://doi.org/10.3390/diagnostics13223463
Chicago/Turabian StyleMalhotra, Ajay. 2023. "Comment on Roman-Filip et al. Non-Aneurysmal Perimesencephalic Subarachnoid Hemorrhage: A Literature Review. Diagnostics 2023, 13, 1195" Diagnostics 13, no. 22: 3463. https://doi.org/10.3390/diagnostics13223463
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