Spontaneous Intracerebral Hemorrhage Secondary to a Parasagittal Meningioma: A Case Report and Review of the Literature

Abstract

Meningiomas are the most prevalent tumors within the central nervous system, with most exhibiting benign characteristics. While they are often discovered incidentally, their growth can lead to symptoms such as headaches, visual changes, dizziness, and seizures. Intratumoral hemorrhage (ITH) within meningiomas is a rare occurrence. This phenomenon carries a poor prognosis, as evidenced by significant rates of morbidity and mortality. This case report describes a unique case of a 52-year-old male who experienced a spontaneous right parietal lobe intracerebral hemorrhage adjacent to the superior sagittal sinus. Subsequent investigations revealed this to be an ITH due to an underlying WHO-grade I meningioma. This case emphasizes that while ITH in meningiomas is rare, prompt recognition and surgical intervention ensure optimal patient outcomes.

Keywords: bleeding inside meningioma; intratumoral hemorrhage; meningioma hemorrhage; parasagittal meningioma; spontaneous intracerebral hemorrhage.

Figure 1. CT head on arrival to the emergency department with views of the axial (A), coronal (B), and sagittal (C) planes

Red arrows: Hyperdense mass, Yellow arrows: Vasogenic edema

Figure 2. Preoperative MRI brain post contrast with views of the axial (A), coronal (B), and sagittal (C) planes

Red arrows: Mass, Blue arrow: Superior sagittal sinus, Yellow arrows: Vasogenic edema

Figure 3. Preoperative MRI brain in the axial plane

A: Mass is isointense to the brain on T1 weighted image (red arrow), B: Mass is hyperintense to the brain on T2 weighted image (yellow arrow), C: Mass is hypointense to the brain on GRE (green arrow) sequence GRE: Gradient echo

Figure 4. Preoperative MRV

The superior sagittal sinus is severely stenotic, although patent (red arrow), and displaced to the left of the midline. MRV: Magnetic resonance venography

Figure 5. Histology of the patient’s WHO grade 1 meningioma with hematoxylin and eosin stain

Spindle cells in a whorled pattern can be seen in sections A, B, and C (black arrows). The psammoma body can be seen in section B (green arrow).

Figure 6. Postoperative CT head with views of the axial (A), coronal (B), and sagittal (C) planes demonstrating interval postoperative changes of right parietal-occipital craniotomy for resection of previously visualized mass

Red arrows: Persistent vasogenic edema in the right parietal-occipital lobes, Yellow arrows: Postoperative pneumocephalus, Green arrows: Tiny amount of blood in the operative bed No mass, hemorrhage, or hydrocephalus are seen. No major vessel vascular territory infarct is seen. No intra or extra-axial fluid collection is seen.

Figure 7. Postoperative MRI brain post contrast in the axial (A), coronal (B), and sagittal (C) planes

Red arrows: Peripheral enhancement is seen at the surgical cavity which most likely represents Surgicel