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Mesencephalic hemorrhages

Clinical and computed tomographic correlations

Departments of Neurology and Psychiatry of the Tulane Medical School, Veterans Administration Hospital of New Orleans, and the Charity Hospital of New Orleans, LA.

We reviewed the clinical and CT findings in six patients with mesencephalic hematomas. All patients were normotensive. Headache and vomiting preceded impairment of consciousness. In all patients, unequal pupils reacted poorly to light but retained the near response. Upgaze was impaired in all patients. CT showed a unilateral nonenhancing midbrain hematoma in all cases and intra-ventricular blood in five. Four-vessel angiography in all cases showed no neoplasm, angioma, or aneurysm. All patients survived with persistent pupillary abnormalities and restriction of upward gaze.

Address correspondence and reprint requests to Dr. Weisberg, Department of Psychiatry and Neurology, 1430 Tulane Avenue, New Orleans, LA 70112.

Accepted for publication September 16, 1985.