Perimesencephalic Hemorrhage: Illustrative Case Report Involving “Spot Sign”

Authors

• Alexander M. Park, New York Medical College
• Nitesh Damodara, Westchester Medical Center
• Chirag Gandhi, Westchester Medical Center
• Gurmeen Kaur, Westchester Medical Center
• Justin Santarelli, Westchester Medical Center

DOI

10.7326/aimcc.2024.1251

Journal Title

Annals of Internal Medicine Clinical Cases

Document Type

Article

Publication Date

7-1-2025

Department

Neurosurgery

Second Department

Neurology

Keywords

Aneurysms, Angiography, Arteries, Case reports, Computed tomography angiography, Hemorrhage, Perimesencephalic, Prognosis, Spot sign, Subarachnoid hemorrhage, Veins

Disciplines

Medicine and Health Sciences

Abstract

Nonaneurysmal perimesencephalic hemorrhage (PMSAH) is a form of subarachnoid hemorrhage with a generally favorable prognosis. The majority of PMSAH cases present with normal cerebral angiography with an unknown exact source of bleeding. However, it is classically thought to be venous in origin. We present a rare case of active or recent venous prepontine “spot sign” extravasation of a 59-year-old man, identified on admission computed tomography angiography but negative on catheter-based angiography and follow-up imaging, strongly suggesting an evident venous cause.

Recommended Citation

Park, A., Damodara, N., Gandhi, C., Kaur, G., & Santarelli, J. (2025). Perimesencephalic Hemorrhage: Illustrative Case Report Involving “Spot Sign”. Annals of Internal Medicine Clinical Cases, 4 (7). https://doi.org/10.7326/aimcc.2024.1251