Spontaneous midbrain hemorrhage.

Spontaneous (nontraumatic) midbrain hemorrhage (SMH) is an uncommon condition whose diagnosis is greatly assisted by the use of cranial computerized tomography. Of 18 cases described in the English language literature, only two were diagnosed without the aid of CT. We report five cases of SMH in five normotensive patients. Vertical gaze palsies were noted in four patients, headache in four, pupillary dysfunction in four, mild hemiplegia in two, unilateral ataxia in two, and unilateral asterixis in one. The diagnosis of SMH had not been considered before CT scanning in any of these patients. All patients had partial to complete recovery. Cerebral angiography in each case showed no abnormalities in the area of the hemorrhage.