| Summary: | Perimesencephalic non-aneurysmal subarachnoid hemorrhage (PNSAH) is characterized by the presence of subarachnoid hemorrhage anterior to the mesencephalon with no evidence of an intracranial aneurysm. Basilar vasospasm following PNSAH is very rarely reported, and typically does not cause clinical symptoms. Here we present a patient with clinical symptomatology due to basilar vasospasm following PNSAH. A 40 year-old male patient was admitted due to severe headache, nausea, vomiting and confusion of sudden onset. It was noted that he had similar symptoms two weeks ago, and diagnosed to have PNSAH. Patient admitted due to exacerbation of previous presenting symptomatology had a four-vessel cerebral digital-subtraction angiography, which revealed vasospasm of basilar artery, together with some regression in PNSAH. He was hospitalized and given symptomatic treatment as hydration, nonsteroidal anti-inflammatory analgesics, and anti-emetics. His symptoms resolved completely within two days, and further intervention was not planned. Control DSA after one month revealed no vasospasm or any other abnormality in basilar artery, in addition with total resorption of PNSAH. Perimesencephalic non-aneurysmal subarachnoid hemorrhage should be distinguished from other subarachnoid hemorrhages, as it has better prognosis and fewer complications. On the other hand, although rare and usually asymptomatic, basilar vasospasm should be kept in mind especially if clinical deterioration occurs during the course of PNSAH.
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