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Perimesencephalic non-aneurysmal subarachnoid haemorrhage
  1. Noorsyakira Osman1,
  2. Nagabathula Ramesh2
  1. 1Emergency Department, Midland Regional Hospital Portlaoise, Laois, Ireland
  2. 2Radiology, Health Service Executive, Laois, Ireland
  1. Correspondence to Dr Noorsyakira Osman, syakira_82{at}

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A 51-year-old woman, without any relevant personal or family history, presented to the emergency department with acute severe occipital headache.

She has no focal neurological deficits or meningeal signs on examination.

Her funduscopy was normal.

Routine bloods including full blood count, renal profile, coagulation screening and cardiac enzymes were unremarkable.

Her baseline chest X-ray and ECG were also normal.

An initial non-contrast CT of the brain was reported as normal.

However, her subsequent CSF analysis at 12 hours post onset of symptoms revealed the presence of red blood cells (14 800/cmm in Tube 1 and 15 000/cmm in Tube 3) and xanthochromia, which raised the suspicion that a careful check of the CT images is needed.

The subtle perimesencephalic haemorrhage was seen on the subsequent review of the axial view …

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