Isolated Acute Nontraumatic Cortical Subarachnoid Hemorrhage

Cuvinciuc, Victor; Viguier, Alain; Calvière, Lionel; Raposo, Nicolas; Larrue, Vincent; Cognard, Christophe; Bonneville, Fabrice

doi:10.3174/ajnr.a1986

Cited by 129 publications

(111 citation statements)

References 61 publications

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“…Another possible mechanism is venous hypertension and subsequent rupture of dilated, valveless, thin-walled, bridging subarachnoid cortical veins devoid of smooth muscle fibers. 6,7,12,16,17) This mechanism is consistent with previous reports, 17,20) and our study showed that cortical SAH usually occurs in the region adjacent to thrombosed veins or sinuses.…”

Section: Discussionsupporting

confidence: 81%

“…One possibility is rupture of venous parenchymal hemorrhagic infarcts into the subarachnoid space. 6,7,12,16) However, none of our 4 patients had findings of hemorrhagic venous infarction on MR imaging or CT. Similarly, intraparenchymal findings of venous hemorrhagic infarction were observed in only one of ten patients with cortical SAH due to CVT.…”

Section: Discussionmentioning

confidence: 96%

“…Neuroimaging revealed different etiologies in the other 3 patients with cortical SAH, cerebral cavernoma (1 patient), and high-grade atherosclerotic stenosis of the intracerebral artery caused by rupture of dilated fragile compensatory pial vessels (1 patient), and cerebral amyloid angiopathy (1 patient). 6) The clinical symptoms and neuroimaging findings of the 4 patients with acute cortical SAH caused by CVT are shown in Table 1. The mean age of patients was 60 ± 22 (mean ± standard deviation) years (range 31-83 years), and the incidence of cortical SAH showed no sex preference.…”

Section: Resultsmentioning

confidence: 99%

“…Such limited SAH along the cortical convexity is referred to as acute non-traumatic cortical SAH, which has many possible causes. 6,20) Acute-stage cerebral venous thrombosis (CVT) is a potential cause of cortical SAH. 1,4,12,16,18) Ten of 233 patients with CVT had evidence of cortical SAH, 17) indicating that the presence of cortical SAH without involvement of the basal cisterns may provide an early sign of underlying CVT.…”

Section: Introductionmentioning

confidence: 99%

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Cortical Subarachnoid Hemorrhage Caused by Cerebral Venous Thrombosis

Oda

Shimoda

Hoshikawa

et al. 2011

Neurol. Med. Chir.(Tokyo)

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Patients with non-traumatic, non-aneurysmal, and non-perimesencephalic subarachnoid hemorrhage (SAH) tend to have clots circumscribed along the cortical convexity, a condition referred to as acute cortical SAH. Cerebral venous thrombosis (CVT) is a potential cause of cortical SAH. The study tried to establish the diagnosis and management of cortical SAH caused by CVT. Retrospective review of 145 patients with non-traumatic SAH identified 15 patients with no ruptured aneurysm. Clinical features were investigated with a specific focus on patients with SAH caused by CVT. Eight of the 15 patients had perimesencephalic SAH, and 7 had cortical SAH. SAH caused by CVT was diagnosed in 4 of the 7 patients with cortical SAH. The cortical SAH involved the unilateral convexity or sylvian cistern and spared the basal cistern on computed tomography in all 4 patients. CVT occurred in the transverse sinus and cortical vein (1 patient), insular vein (1 patient), and cortical vein (2 patients). Identification of thrombosed veins or sinuses was established directly by T 2 *-weighted and diffusion-weighted magnetic resonance (MR) imaging in the acute stage and diffusion-weighted and T 1 -weighted MR imaging in the subacute stage. All patients had cortical swelling without findings of venous hemorrhagic infarction on T 2 *-weighted MR imaging. None of the 4 patients received active treatment, and all had favorable outcomes. CVT in patients with non-traumatic cortical SAH should be first excluded as a potential hemorrhagic cause by MR imaging for thrombosed veins or sinuses before initiating antifibrinolytic therapy.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 96%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cortical Subarachnoid Hemorrhage Caused by Cerebral Venous Thrombosis

Oda

Shimoda

Hoshikawa

et al. 2011

Neurol. Med. Chir.(Tokyo)

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“…6 The exact mechanism of cortical SAH caused by CVT is unknown. One possibility is the rupture of venous parenchymal hemorrhagic infarcts into the subarachnoid space, 15,16 although signs of hemorrhagic venous infarction were not found in our patient. Another possible mechanism is venous hypertension and subsequent rupture of dilated, valueless, thin-walled, bridging subarachnoid cortical veins devoid of smooth muscle fibers.…”

Section: Discussionmentioning

confidence: 56%

Cerebral Venous Thrombosis with Subarachnoid Hemorrhage: a Case Report

Arévalo-Lorido¹,

Carretero-Gómez²

2014

Clinical Medicine & Research

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Cerebral venous thrombosis (CVT) presenting as subarachnoid hemorrhage (SAH) is infrequent. We present the case of a man with CVT of the right transverse sinus who presented with a SAH in the right parietal sinus. In this case, we describe a hyper-homocysteinemia in a heterozygous patient for the methylenetetrahydrofolate reductase C667T mutation. Our report highlights the value of an early diagnosis of CVT, the importance of identifying possible causes that could be reversed with an appropriate treatment, and the controversy about the timing for starting anticoagulation therapy in such cases.

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Imaging the future of stroke: II. Hemorrhage

Liebeskind

2010

Annals of Neurology

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Bleeding into the brain or adjacent structures is one of the most devastating neurological conditions, incurring tremendous emotional, financial, and societal costs. Imaging is essential to differentiate variants of hemorrhage, as the clinical features may be insufficient. A comprehensive approach to hemorrhage therefore relies on imaging to disclose pathophysiology, elucidate mechanisms, and thereby open further avenues to effective treatment. Hemorrhage patterns from superficial to deep locations in the brain are surveyed in this work, noting myriad potential causes and the influential pathophysiology of arterial ischemia, venous hypertension, and microvascular dysfunction. Recent progress of imaging studies and novel techniques to evaluate hemorrhage are explored. For decades, only computed tomography was available to define a hematoma without corroborating evidence of other pathology whereas multimodal computed tomography and magnetic resonance imaging, including noninvasive imaging of brain tissue, vessels, and perfusion, have now radically altered clinical practice. Imaging of the blood-brain barrier, cerebral microbleeds, coexistent ischemia, associated vascular lesions, and markers of hemorrhage expansion is possible with routine protocols akin to diagnostic strategies for ischemic stroke. Imaging applications for hemorrhagic transformation, venous thrombosis, and microvascular disorders are considered with a perspective that balances concern for hemorrhage with prevention of ischemia as these processes are often intertwined and clinical conundrums arise. Imminent imaging advances are anticipated with increased use of detailed imaging for hemorrhage and overlap with cerebral ischemia. Numerous questions abound regarding optimal management of hemorrhage and definitive treatments are lacking, yet imaging of pivotal pathophysiology offers tremendous opportunity for future progress in combating this debilitating condition.

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Isolated Acute Nontraumatic Cortical Subarachnoid Hemorrhage

Cited by 129 publications

References 61 publications

Cortical Subarachnoid Hemorrhage Caused by Cerebral Venous Thrombosis

Cortical Subarachnoid Hemorrhage Caused by Cerebral Venous Thrombosis

Cerebral Venous Thrombosis with Subarachnoid Hemorrhage: a Case Report

Imaging the future of stroke: II. Hemorrhage

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