Introduction: Spontaneous mesencephalic hemorrhages are very unusual, specially those located in the tectal region. Hypertension is a less important factor that in other classical locations. Other etiologies reported are arteriovenous malformations, coagulation disorder and trauma. We describe two patients with spontaneous hemorrhage of the quadrigeminal plate.
Clinical case: Case 1: a non-hypertensive 30 year-old man who suddenly presented headache, nausea, diplopia and left hemisensory deficit. Twenty-four hours later he lost consciousness but was again alert within five hours. Examination revealed upward and downward gaze palsy and limited convergence. The patient recovered completely within six weeks. Case 2: a 38 year-old man without hypertension, who suddenly developed dizziness, occipital headache, nausea and diplopia. On examination, there was impaired upward and downward gaze, limitation of convergence and right arm hyposthesia. After eight weeks examination showed a mild limitation of upward voluntary gaze. CT and MR imaging studies revealed a small quadrigeminal hemorrhage in both cases.
Conclusions: Hemorrhages located at mesencephalic tectal region are infrequent. They have a typical clinical presentation and outcome is usually favourable. Hypertension is less common than in hemorrhages of other locations. A significant proportion of cases can be attributed to occult vascular malformations.