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.