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Case Reports
. 2023 Mar:171:8-9.
doi: 10.1016/j.wneu.2022.12.007. Epub 2022 Dec 8.

Meningioma Presenting with Spontaneous Venous Intraparenchymal Hemorrhage

Alexandra Giantini-Larsen  1 , Zaki Abou-Mrad  1 , Nelson S Moss  2
Affiliations
Case Reports

Meningioma Presenting with Spontaneous Venous Intraparenchymal Hemorrhage

Alexandra Giantini-Larsen et al. World Neurosurg. 2023 Mar.

Abstract

A 65-year-old woman with a known right-sided, dural-based lesion and metastatic pancreatic neuroendocrine tumor presented with multiple days of progressive lethargy and left-sided weakness culminating with obtundation and dilated pupils. Computed tomography demonstrated an acute right convexity subdural hematoma and a frontotemporal intraparenchymal hemorrhage with 1.3 cm of midline shift, uncal herniation, and an increase in size of now a hemorrhagic dural-based lesion. She underwent emergency hemicraniectomy for evacuation of subdural hematoma and resection of hemorrhagic meningioma with excellent postoperative result including improvement in midline shift and gross total resection of lesion. Pathology was consistent with a World Health Organization grade II meningioma with a chordoid component. She underwent adjuvant stereotactic radiosurgery and cranioplasty and made a full neurologic recovery. Identification of hemorrhagic meningioma as the underlying pathology causing multicompartmental hemorrhage is crucial. We recommend single-stage decompression with extraaxial clot evacuation and resection of the meningioma when feasible.

Keywords: Hemicraniectomy; Intraparenchymal hemorrhage; Meningioma; Subdural hematoma.

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Conflict of interest statement

Conflict of Interest:

Alexandra M. Giantini Larsen, MD has no financial or personal relationships with other people or organizations that could inappropriately bias this work.

The other co-authors listed have confirmed there are no conflicts of interest to disclose.

Figures

Figure Legend:
Figure Legend:
A 65-year-old woman with metastatic pancreatic neuroendocrine tumor and right sphenoid wing meningioma (A) presented with three days of progressive lethargy and acute obtundation with dilated ipsilateral pupil. Emergent CT scan (B,C) demonstrated an acute right convexity subdural hematoma and frontotemporal intraparenchymal hemorrhage with 1.3 cm of midline shift, effacement of the right lateral ventricle and right uncal herniation, and hemorrhagic expansion of the dural based lesion. She underwent emergent hemicraniectomy with resection of the meningioma with significant decompression of the subjacent brain structures as shown on postoperative CT obtained on day 0 (D) and post-contrast T1 DWI (E) MR sequences obtained on day 1 (F). Pathology was consistent with World Health Organization Grade II meningioma with chordoid component and she underwent cranioplasty (G). By 2 months postoperatively she experienced full neurological recovery.
See this image and copyright information in PMC

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