Presentation
Severe headache, dizziness and other non-specific symptoms. No history of trauma.
Patient Data
An acutely intraventricular hemorrhage with hyperdense blood is seen within the right lateral ventricle with lesser extension to the occipital horn of the left lateral ventricle.
Otherwise, no other significant abnormalities.
Conclusion:
An isolated primary acute intraventricular hemorrhage and CT angiography recommended to clarifying the underlying cause.
Follow up after 4 days of conservative treatment showing:
Decreased the amount of the previously described intraventricular hemorrhage, now it is seen localized within the occipital horn of the right lateral ventricle.
Normal caliber and course of both common carotid, both internal and both external carotid arteries.
Both vertebral arteries appear normal in caliber and configuration.
There is no evidence of narrowing, dissection, irregularity, aneurysm or occlusion.
Distal, petrous, cavernous and supraclinoid parts of the internal carotid artery are normal.
Both vertebral arteries and basilar are normal.
Normal appearance of ACA, MCA, PCA, anterior communicating and posterior communicating arteries.
There is no evidence of narrowing, dissection, irregularity, aneurysm or occlusion.
Case Discussion
A 50 years old male presented to our emergency department with acute severe headache. He was agitated and confused. Neurologic examination did'nt show any focal signs. Blood pressure was normal. A CT scan was performed which showed intraventricular hemorrhage without an evident bleeding source and recommend CT angiography . A CT-angiography did not reveal an aneurysm or a vascular malformation
Primary hemorrhage in the ventricular system without a recognizable parenchymal component is very rare in adults and seldom described. Awareness of possible causes is important in order to guide patient management. After elimination of a traumatic cause, numerous etiologies remain possible.
In a high number of cases, the cause remains unknown (as in our case ). Vascular and non-vascular causes should be searched through an imaging workup (with CT angiography, MRI and catheter angiography when necessary) and correlation with clinical information to yield a diagnosis.
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