Nonaneurysmal perimesencephalic hemorrhage is associated with deep cerebral venous drainage anomalies: A systematic literature review and meta-analysis

A. Rouchaud, V. T. Lehman, M. H. Murad, A. Burrows, H. J. Cloft, E. P. Lindell, D. F. Kallmes, W. Brinjikji

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

BACKGROUND AND PURPOSE: Mechanisms underlying bleeding in nonaneurysmal perimesencephalic SAH remain unclear. Previous investigators have suggested a relationship between nonaneurysmal perimesencephalic SAH and primitive venous drainage of the basal vein of Rosenthal. We performed a meta-analysis to evaluate the relation between primitive basal vein of Rosenthal drainage and nonaneurysmal perimesencephalic SAH. MATERIALS AND METHODS: We performed a comprehensive literature search of all studies examining the prevalence of primitive basal vein of Rosenthal drainage in patients with aneurysmal SAH and nonaneurysmal perimesencephalic SAH. Data collected were primitive basal vein of Rosenthal drainage (direct connection of perimesencephalic veins into the dural sinuses instead of the Galenic system) in at least 1 cerebral hemisphere, normal bilateral basal vein of Rosenthal drainage systems, and the number of overall primitive venous systems in the nonaneurysmal perimesencephalic SAH and aneurysmal SAH groups. Statistical analysis was performed by using a random-effects meta-analysis. RESULTS: Eight studies with 888 patients (334 with nonaneurysmal perimesencephalic SAH and 554 with aneurysmal SAH) and 1657 individual venous systems were included. Patients with nonaneurysmal perimesencephalic SAH were more likely to have a primitive basal vein of Rosenthal drainage in at least 1 hemisphere (47.7% versus 22.1%; OR, 3.31; 95% CI, 2.15-5.08; P < .01) and were less likely to have bilateral normal basal vein of Rosenthal drainage systems than patients with aneurysmal SAH (18.3% versus 37.4%; OR, 0.27; 95% CI, 0.14-0.52; P < .01). When we considered individual venous systems, there were higher rates of primitive venous systems in patients with nonaneurysmal perimesencephalic SAH than in patients with aneurysmal SAH (34.9% versus 15.3%; OR, 3.90; 95% CI, 2.37- 6.43; P < .01). CONCLUSIONS: Patients with nonaneurysmal perimesencephalic SAH have a higher prevalence of primitive basal vein of Rosenthal drainage in at least 1 hemisphere than patients with aneurysmal SAH. This finding suggests a venous origin of some nonaneurysmal perimesencephalic SAHs. A primitive basal vein of Rosenthal pattern is an imaging finding that has the potential to facilitate the diagnosis of nonaneurysmal perimesencephalic SAH.

Original languageEnglish (US)
Pages (from-to)1657-1663
Number of pages7
JournalAmerican Journal of Neuroradiology
Volume37
Issue number9
DOIs
StatePublished - Sep 2016

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

Fingerprint

Dive into the research topics of 'Nonaneurysmal perimesencephalic hemorrhage is associated with deep cerebral venous drainage anomalies: A systematic literature review and meta-analysis'. Together they form a unique fingerprint.

Cite this