Nonaneurysmal perimesencephalic SAH (NAPSAH)

What is nonaneurysmal perimesencephalic SAH (NAPSAH)? 

In 15% of SAH patients imaging studies fail to demonstrate the source of bleeding.

Approximately 38% of these patients have NAPSAH.

Nonaneurysmal perimesencephalic SAH is confirmed in the presence of a negative CTA or DSA in patients with the following head CT scan pattern:

  • Center of hemorrhage is located immediately anterior to the midbrain, with or without extension of blood to the anterior part of the ambient cistern or to the basal part of the Sylvian fissures;
  • No complete filling of the anterior interhemispheric fissure and no extension to the lateral Sylvian fissures, except for minute amounts of blood; and
  • Absence of frank intraventricular blood.
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