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Abstract Details

Straight Sinus Stenosis: A Proposed Cause for Non-aneurysmal Peri-mesencephalic Hemorrhage
Cerebrovascular Disease and Interventional Neurology
Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)
088
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Non-aneurysmal peri-mesencephalic hemorrhage (NAPH) was first described by Van Gijn J et al. in 1985 as an accumulation of blood around the midbrain, followed by a normal four-vessel angiography. The source of bleeding has been intriguing experts over the years and a variety of possible causes have been proposed. This study describes a case of NAPH and use of a novel neuroimaging technique which suggests further insight on what might be the cause for the bleeding.
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Case: 58-year-old male presented with an orgasmic headache, which developed steadily over a period of 2 hours, culminating in loss of consciousness by the time of hospital arrival. He had no focal deficits. Head CT demonstrated subarachnoid hemorrhage around the midbrain and pons. CTA and subsequent two Digital Subtraction Angiograms (DSA) 5 days apart were negative for intracranial aneurysm or arteriovenous fistula. Both, CTA and DSA demonstrated focal stenosis at the junction of the internal cerebral veins and straight sinus stenosis. Patient remained asymptomatic and further workup was delayed due to COVID-19. Time-Resolved 4D flow Magnetic Resonance Venogram (MRV) demonstrated hemodynamic effects of stenosis on the flow through the venous sinus. The flow through the sinus was pulsatile with reversal of flow direction just proximal to the stenosis for part of the cycle.
Sparsity of literature proposing venous stenosis as an etiology of NAPH prompted us to write this single case report. Dynamic MRV findings provided evidence of hemodynamic effects of stenosis suspected on prior imaging. We propose that pressure and flow alterations resulting from the focal stenosis at the origin of the straight sinus as the cause of NAPH in our patient.  Dynamic MRV may play a role in further diagnostic efforts for NAPH.
Authors/Disclosures
Fernanda Jacinto Pereira Teixeira, MD
PRESENTER 		Dr. Jacinto Pereira Teixeira has nothing to disclose.
No disclosure on file
No disclosure on file
J. P. Mohr, MD, FÂ鶹´«Ã½Ó³»­ (Neurological Institute) The institution of Dr. Mohr has received research support from NINDS Grant R01 NS099268 NIH-NINDS .