Perimesencephalic Non-aneurysmal Subarachnoid Hemorrhage Caused by Cavernous Sinus Thrombosis-Case Report-

Kurosu, Akihiro; Suzukawa, Katsumi; Amo, M.R. del; Horinaka, Naoaki; Arai, Hajime

doi:10.2176/nmc.47.258

Cited by 14 publications

(13 citation statements)

References 6 publications

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“…All of our illustrated cases of PSH can be readily explained by the underlying abnormalities in the venous circulation. PSH in association with cavernous sinus thrombosis 24 and jugular venous occlusion 25 have also been recently reported. Underlying venous pathology appears to be a common denominator and may have been an important predisposing factor for the development of PSH.…”

Section: Discussionmentioning

confidence: 89%

Underlying Venous Pathology Causing Perimesencephalic Subarachnoid Hemorrhage

Lee

Koh

Chung

et al. 2009

Can. j. neurol. sci.

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638Perimesencephalic subarachnoid hemorrhage (PSH) has become well recognized as a distinct type of subarachnoid hemorrhage (SAH). This clinical entity of unknown etiology is defined as blood in the cisterns around the midbrain. Perimesencephalic subarachnoid hemorrhage constitutes approximately 10% of all patients with SAH and two thirds of those with a normal angiogram 1-3 . Patients with PSH have an excellent outcome without increased morbidity or mortality from recurrent bleeding and ischemia [3][4][5] . Both venous and arterial sources of bleeding have been suggested 3,5,6 to explain this distinct subset of SAH. Definitive evidence supporting either of these speculations, however, still remains elusive. We report here three cases of PSH that most likely have arisen from an underlying abnormality in the venous system. The presence of underlying venous pathology predisposed the draining venules to rupture, ultimately leading to PSH. The authors speculate that the underlying venous pathology in our cases could provide theoretical clues to the anatomic origin of PSH in general.ABSTRACT: Background: Perimesencephalic subarachnoid hemorrhage (PSH) is a relatively benign clinical entity with a low risk of recurrent bleeding. The precise etiology of PSH has not yet been determined. We report here three cases of PSH with clinical and radiological features that support a venous system as a cause. Case Presentation: The first patient, a 72-year-old woman, had PSH and venous hemorrhagic infarct in the left thalamus on non-contrast CT. Subsequent cerebral angiography revealed widespread thrombosis in the cerebral venous system, a potential cause for reflux overflow hemorrhage. The second patient, a 55-year-old man with an established diagnosis of neuro-Behçet's disease, a well-known cause for cerebral venulitis, presented with PSH one year later. The third patient, a 39-year-old female, with incomplete Behçet's disease was admitted with PSH. Discussion: Current concepts on the anatomic origin and the possible pathophysiologic mechanism leading to PSH are discussed. The underlying pathological conditions in the venous system in our cases provide theoretical clues to the anatomic origin of PSH in general.RÉSUMÉ: Pathologie veineuse sous-jacente causant une hémorragie sous-arachnoïdienne périmésencéphalique. Contexte : L'hémorragie sousarachnoïdienne périmésencéphalique (HSP) est une entité clinique relativement bénigne comportant un risque faible de saignement récurrent. L'étiologie précise de l'HSP n'a pas encore été déterminée. Nous rapportons trois observations d'HSP ainsi que les manifestations cliniques et radiologiques qui sont en faveur d'un lien de causalité avec le système veineux. Observations : La première patiente, une femme âgée de 72 ans qui a subi une HSP, présentait un infarctus hémorragique veineux dans le thalamus gauche à la tomodensitométrie sans substance de contraste. Des angiographies subséquentes ont montré une thrombose étendue du système veineux cérébral, une cause potentielle de l'hémorragie par...

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Section: Discussionmentioning

confidence: 89%

Underlying Venous Pathology Causing Perimesencephalic Subarachnoid Hemorrhage

Lee

Koh

Chung

et al. 2009

Can. j. neurol. sci.

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“…The potential pathogenesis may include a venous system variant [20], capillary abnormality, intracranial basilar dissection, ruptured perforating artery [37], cavernous malformation [38], or capillary telangiectasia [15]. Although both arterial and venous origins for the SAH have been proposed, most of the studies favor a venous source of PMN-SAH [39].…”

Section: Discussionmentioning

confidence: 99%

Management of Spontaneous Subarachnoid Hemorrhage Patients with Negative Initial Digital Subtraction Angiogram Findings: Conservative or Aggressive?

Fang

Shi

et al. 2017

BioMed Research International

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Background. The ideal management of SAH patients with negative initial DSA findings remains unresolved. Objective. (i) To present risk factors, clinical courses, and outcomes in different types of SAH patients with negative DSA findings; (ii) to explore the differences of basal vein between aSAH patients and NASAH patients; and (iii) to evaluate the value of repeated DSA for these patients. Methods. All SAH patients with negative initial DSA findings between 2013 and 2015 in our hospital were enrolled and were further categorized as perimesencephalic SAH (PMN-SAH) or nonperimesencephalic SAH (nPMN-SAH). Risk factors, clinical courses, outcomes, and the basal vein drainage patterns were compared. Results. A total of 137 patients were enrolled in the present study. The PMN-SAH group had better GOS and mRS values at 1-year follow-up. Moreover, the nPMN-SAH group had a higher rate of complications. The basal vein drainage pattern showed significant difference when comparing each of the NASAH subtypes with aSAH groups. There was a significant higher rate of a responsible aneurysm in nPMN-SAH group upon repeated DSA. Conclusions. SAH patients with negative initial DSA findings had benign clinical courses and outcomes. Repeated DSA studies are strongly advised for patients with the nPMN-SAH pattern.

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“…4,[6][7][8]11,12,16,[19][20][21]23,24,[29][30][31][32][33][34] These conditions are often congenital and present in younger patients; indeed, this variant of SAH was found in children on several occasions. [35][36][37] PMSAH may be associated with cavernous sinus thrombosis 38 or physical exertion causing trauma to anomalous veins. 11,32,34,38 Other reports suggest ischemia of the thalamoperforating and lenticulostriate vessels causing PMSAH.…”

Section: Discussionmentioning

confidence: 99%

“…[35][36][37] PMSAH may be associated with cavernous sinus thrombosis 38 or physical exertion causing trauma to anomalous veins. 11,32,34,38 Other reports suggest ischemia of the thalamoperforating and lenticulostriate vessels causing PMSAH. [39][40][41] However, our data demonstrate that the two populations of diffuse SAH and PMSAH largely harbor similar rates of hypertension and smoking.…”

Section: Discussionmentioning

confidence: 99%