Parimesencephalic hemorrhage is a rare type of non-aneurysmal subarachnoid hemorrhage (SAH). It is characterized by bleeding around the midbrain region of the brainstem, but often confound with SAH and intraparenchymal hemorrhage (IPH). Unlike other types of SAH, parimesencephalic hemorrhage has a more favorable prognosis. It remains unclear if conventional angiogram is surely necessary in patients with suspected parimesencephalic hemorrhage. We presented an unusual case of a 45-year-old man with initial presentation of severe headache, who received conventional angiogram that unfortunately resulted in multifocal embolic ischemic infarcts. Another 48-year-old woman was admitted to hospital with similar presentation, a diagnosis of parimesencephalic hemorrhage was given based on computed tomography (CT) angiogram (CTA), who made a fully recovery. Our real-world practice experience demonstrated that conventional angiography is not necessary in patients with suspected parimesencephalic hemorrhage to avoid potential periprocedural embolic events.