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KMID : 0911820200210010019
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Korean Journal of Headache
2020 Volume.21 No. 1 p.19 ~ p.21
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A Case of Handstand Induced Perimesencepahalic Nonaneurysmal Subarachnoid Hemorrhage
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Ha Joon-Young
Lee Ji-Yong
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Abstract
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Perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSAH) is characterized by accumulation of blood mainly or only in the cisterns around the midbrain, normal angiography and a benign course. Previous investigators have suggested primitive venous drainage of the basal vein of Rosenthal, venous hypertension and arterial causes other than an aneurysm as causes of PNSAH. However, it remains unclear. A 47-year-old man visited due to severe occipital thunderclap headache that occurred during handstand 4 days ago. Brain CT showed localized SAH in the prepontine cistern. CT cerebral angiography and digital subtraction cerebral angiography did not reveal any evidence of cerebral aneurysm, arteriovenous malformation or venous abnormality. Brain CT after 14 days demonstrated disappearance of SAH in the prepontine cistern. We experienced a case of handstand induced PNSAH. Physical exertion including the Vaslsalva maneuver such as handstand could be an important predisposing factor for PNSAH.
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KEYWORD
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Handstand, Perimesencepahalic nonaneurysmal subarachnoid hemorrhage, Thunderclap headache
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