Perimesencephalic Subarachnoid Hemorrhage Presenting with Headache and Ocular Hemorrhage in a Patient with Chemotherapy-induced Severe Thrombocytopenia

Lee, Hyo Jeong; Park, Moon Ho; Kim, Jong Hun

doi:2026.44.3.226

J Korean Neurol Assoc > Volume 44(3); 2026 > Article

Case Report

Journal of the Korean Neurological Association 2026;44(3): 226-230. doi: https://doi.org/10.17340/jkna.2026.0020

항암 치료 유발 혈소판감소증 환자에서 두통과 안구출혈로 발현한 중뇌 주위 지주막하출혈

이효정, 박문호, 김종헌

고려대학교안산병원 신경과

Perimesencephalic Subarachnoid Hemorrhage Presenting with Headache and Ocular Hemorrhage in a Patient with Chemotherapy-induced Severe Thrombocytopenia

Hyo Jeong Lee MD, Moon Ho Park MD, PhD, Jong Hun Kim MD, PhD

Department of Neurology, Korea University Ansan Hospital, Ansan, Korea

Corresponding Author: Jong Hun Kim ,Tel: +82-31-412-5150, Fax: +82-31-412-5154, Email: jh7521@naver.com

Received: March 30, 2026 Revised: May 6, 2026 Accepted: May 11, 2026 Published online: August 1, 2026

Abstract

A 26-year-old female with severe thrombocytopenia (platelet count <20,000/μL) following combination chemotherapy (cisplatin, paclitaxel, pembrolizumab, and bevacizumab) for cervical cancer presented with new-onset headache and ocular hemorrhage. Perimesencephalic subarachnoid hemorrhage (pmSAH) was identified, which was subsequently complicated by disproportionate cerebral vasospasm and transient oculomotor nerve palsy. This case demonstrates that pmSAH, which is generally considered a benign venous hemorrhage, can follow an unusual course in the setting of profound bleeding diathesis and chemotherapy-induced vascular injury.

Key Words: Subarachnoid hemorrhage | Thrombocytopenia | Headache