Subarachnoid Hemorrhage: A Rare Presentation of Cerebral Venous Thrombosis

Sztajzel, Roman; Coeytaux, Alessandra; Dehdashti, Amir R.; Delavelle, J.; Sinnreich, Michael

doi:10.1111/j.1526-4610.2001.01161.x

Cited by 28 publications

(21 citation statements)

References 8 publications

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“…Our first patient had PSH with direct evidence of wide spread venous thrombosis on cerebral angiography. Reports of SAH in association with cerebral venous thrombosis is very rare 15 . A feasible explanation for PSH in the first patient is that the thrombosis of the deep cerebral venous system including the great vein of Galen and straight sinus may have exerted retrograde hydrostatic pressure into the veins which bridge the perimesencephalic subarachnoid space.…”

Section: Discussionmentioning

confidence: 99%

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: 99%

Underlying Venous Pathology Causing Perimesencephalic Subarachnoid Hemorrhage

Lee

Koh

Chung

et al. 2009

Can. j. neurol. sci.

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“…Among those, subarachnoid hemorrhage (SAH) is regarded as one of the rarest presentations and of relatively recent recognition 2,3 . Isolated cortical vein thrombosis (ICoVT), i.e.…”

mentioning

confidence: 99%

Subarachnoid hemorrhage in isolated cortical vein thrombosis: are presentation of an unusual condition

Bittencourt

Palma-Filho

Domingues

et al. 2009

Arq. Neuro-Psiquiatr.

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“…Both intraparenchymal and subarachnoid hemorrhage complicated the venous infarction, which was reported previously [13]. Because of the frequent association of hemorrhage with the thrombotic event, therapy for this disorder is controversial.…”

Section: Discussionmentioning

confidence: 88%

Heparin-Induced Thrombocytopenia and Cerebral Venous Sinus Thrombosis: Case Report and Literature Review

Fesler

Creer²,

Richart

et al. 2010

Neurocrit Care

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A review of the previous 10 case reports in the literature confirms that HIT-related CVST is often a fatal condition, particularly when diagnosed in comatose patients. Because the diagnosis is rare and often delayed relative to initial presentation, prevention is the key to improve patient outcomes. Newer anticoagulants with different mechanism of action than heparin are currently under review by the FDA; they will facilitate prevention of HIT-related CVST and other HIT-related neurological complications.

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Subarachnoid Hemorrhage: A Rare Presentation of Cerebral Venous Thrombosis

Cited by 28 publications

References 8 publications

Underlying Venous Pathology Causing Perimesencephalic Subarachnoid Hemorrhage

Underlying Venous Pathology Causing Perimesencephalic Subarachnoid Hemorrhage

Subarachnoid hemorrhage in isolated cortical vein thrombosis: are presentation of an unusual condition

Heparin-Induced Thrombocytopenia and Cerebral Venous Sinus Thrombosis: Case Report and Literature Review

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