Convexity Subarachnoid Hemorrhage Due to Large Artery Atherosclerotic Stenosis or Occlusion

Introduction: Convexity subarachnoid hemorrhage (cSAH) is a rare subtype of nontraumatic subarachnoid hemorrhage. Large artery atherosclerotic stenosis or occlusion has emerged as a prevalent etiology in China. The diagnosis of cSAH is primarily based on imaging examinations. However, there are no established guidelines or consensus for its treatment. Case Report: This report presented 3 cases of cSAH associated with atherosclerotic stenosis or occlusion. All 3 patients had significant large-artery stenosis or occlusion. In 2 cases (cases 1 and 3), computed tomography (CT) angiography revealed stenosis of the right middle cerebral artery and internal carotid artery, while the third case (case 2) exhibited bilateral internal carotid and middle cerebral artery stenosis. Two patients (cases 1 and 2) were treated with antiplatelet therapy under close monitoring of vital signs and serial CT scans, resulting in significant symptom improvement and no evidence of rebleeding on the follow-up CT scan. The other patient (case 3), who underwent balloon angioplasty of the right internal carotid artery, experienced symptom worsening, including brain herniation and poor prognosis. Conclusion: This report summarized the clinical presentations, imaging findings, etiology, treatments, and prognoses of 3 cSAH cases, which may provide a reference for the standardized diagnosis and management of such patients.