Angiogram Negative Subarachnoid Hemorrhage Revealed as Midbasilar Perforator Pseudoaneurysm Rupture on Delayed Angiography
- Author:
Joon Hyeoung KIM
1
;
Jun Soo BYUN
;
Min Ho KONG
;
Se Youn JANG
;
Jung Hee KIM
;
Sunghoon KIM
Author Information
- Publication Type:Case Report
- From: Journal of Neurointensive Care 2025;8(2):62-66
- CountryRepublic of Korea
- Language:English
- Abstract: Angiogram-negative subarachnoid hemorrhage (SAH) represents a diagnostic challenge because rebleeding risk persists despite negative initial angiography. We report a rare case of a 65-year-old man presenting with diffuse SAH on initial CT but with negative CTA and transfemoral cerebral angiography (TFCA). Serial follow-up CT scans demonstrated gradual resolution of subarachnoid blood except for persistent prepontine cisternal hemorrhage. On hospital day 7, repeat TFCA revealed a bilobulated pseudoaneurysm arising from a midbasilar perforator artery. The lesion was treated using a modified stent-assisted coiling technique involving partial coil deployment, achieving complete angiographic obliteration with parent artery preservation. Post-procedural diffusion-weighted MRI demonstrated a left pontine infarction, but the patient achieved meaningful functional recovery and returned to work at the 3-month follow-up. This case underscores the necessity of repeat angiography in diffuse angiogram-negative SAH and highlights tailored endovascular strategies for fragile basilar perforator pseudoaneurysm.
