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Venous drainage in perimesencephalic hemorrhage

Irene C van der Schaaf1, Birgitta K Velthuis, Alida Gouw

  • 1Department of Radiology, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. irenemarieke@yahoo.com

Stroke
|May 29, 2004
PubMed
Abstract

Insights

Perimesencephalic nonaneurysmal hemorrhage (PMH) patients more frequently exhibit primitive venous drainage compared to aneurysmal subarachnoid hemorrhage (aSAH) patients. The location of PMH correlates with this abnormal venous drainage, supporting a venous origin.

Area of Science:

  • Neurology
  • Radiology
  • Vascular Imaging

Background:

  • Perimesencephalic nonaneurysmal hemorrhage (PMH) is characterized by subarachnoid blood around the midbrain.
  • Clinical and radiological findings suggest a venous origin for PMH.

Purpose of the Study:

  • To compare the midbrain venous drainage patterns between patients with PMH and aneurysmal subarachnoid hemorrhage (aSAH).
  • To investigate the relationship between venous drainage variants and the location of hemorrhage in PMH.

Main Methods:

  • Computed tomography angiography (CTA) scans of 55 PMH patients and 42 aSAH patients were reviewed.
  • Venous drainage was classified as normal continuous, normal discontinuous, or primitive variant.
  • In PMH patients, the side of the primitive venous drainage was compared with the side of the bleeding.

Main Results:

  • A primitive venous drainage variant was observed in 53% of PMH patients versus 19% of aSAH patients.
  • In PMH patients with unilateral primitive drainage, hemorrhage was consistently located on the side of the primitive drainage (100%).
  • Hemorrhage was not predominantly found on the side with normal venous drainage in PMH patients.

Conclusions:

  • Patients with PMH more frequently present with primitive venous drainage directly into dural sinuses compared to controls.
  • The location of perimesencephalic hemorrhage aligns with the side of the primitive venous drainage.
  • These findings provide further evidence supporting a venous etiology for PMH.

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