Published Online
on May 27, 2004

A more recent version of this article appeared on July 1, 2004

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Submitted on March 12, 2004
Revised on April 7, 2004
Accepted on April 29, 2004

Venous Drainage in Perimesencephalic Hemorrhage

Irene C. van der Schaaf MD^*; Birgitta K. Velthuis MD; Alida Gouw MSc; and Gabriel J.E. Rinkel MD

From the Departments of Radiology (I.C.v.d.S., B.K.V.) and Neurology (A.G., G.J.E.R.), University Medical Centre Utrecht, the Netherlands.

^* To whom correspondence should be addressed. E-mail: irenemarieke{at}yahoo.com.

Background and Purpose--In perimesencephalic nonaneurysmal hemorrhage (PMH), subarachnoid blood accumulates around the midbrain. Clinical and radiological characteristics suggest a venous origin of PMH. We compared the venous drainage of the midbrain between patients with PMH and aneurysmal subarachnoid hemorrhage (aSAH) by means of computed tomography angiography (CTA).

Methods--CTAs of 55 PMH patients and 42 aSAH patients with a posterior circulation aneurysm were reviewed. Venous drainage was classified into: (1) normal continuous: the basal vein of Rosenthal is continuous with the deep middle cerebral vein and drains mainly to the vein of Galen (VG); (2) normal discontinuous: drainage anterior to uncal veins and posterior to VG; and (3) primitive variant: drainage to other veins than VG. Additionally, we compared in PMH patients the side of the primitive variant and side of the bleeding.

Results--A primitive variant was present on one or both hemispheres in 53% of PMH patients with PMH (95% CI, 40% to 65%) and in 19% of aSAH patients (95% CI, 10% to 33%). In all 16 PMH patients with a unilateral primitive drainage, blood was seen on the side of the primitive drainage (100%; 95% CI, 81% to 100%); blood was never found mainly on the side with normal drainage.

Conclusions--Patients with PMH have a primitive venous drainage directly into dural sinuses instead of via the vein of Galen more often than do controls. Moreover, the side of the perimesencephalic hemorrhage relates to the side of the primitive drainage. These results further support a venous origin of PMH.

Key words: perimesencephalic hemorrhage • subarachnoid hemorrhage • computed tomography • angiography

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