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Underlying Venous Pathology Causing Perimesencephalic Subarachnoid Hemorrhage

Published online by Cambridge University Press:  02 December 2014

Jaejoon Lee ,
Eun-Mi Koh ,
Chin-Sang Chung ,
Seung-Chul Hong ,
Yong-Bum Kim ,
Pil-Wook Chung ,
Bum-Chun Suh  and
Heui-Soo Moon
Jaejoon Lee
Affiliation:
Department of Medicine, Samsung Medical Centre
Eun-Mi Koh
Affiliation:
Department of Medicine, Samsung Medical Centre
Chin-Sang Chung
Affiliation:
Department of Neurology, Samsung Medical Centre
Seung-Chul Hong
Affiliation:
Department of Neurosurgery, Samsung Medical Centre
Yong-Bum Kim
Affiliation:
Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Pil-Wook Chung
Affiliation:
Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Bum-Chun Suh
Affiliation:
Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Heui-Soo Moon*
Affiliation:
Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
*
Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Abstract

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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.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 36 , Issue 5 , September 2009 , pp. 638 - 642
Copyright
Copyright © The Canadian Journal of Neurological 2009

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