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A recurrent meningioma associated with an intracranial aneurysm, such as that described here, appears to be unique. Review of the literature, from Dandy's classic monograph ' on intracranial aneurysms in 1944 to the present, failed to reveal a report of such a lesion. Nor did Cushing and Eisenhardt, 2 in their monograph on meningiolnas published in 1938, indicate that an aneurysm had complicated any of the many recurrent meningiomas in their vast experience. Bleeding aneurysm as a consequence of the removal of a primary tumor is, on the contrary, well known. Hemorrhage from such an aneurysm was reported by Finkemeyer 4 in 1955. Some 17 days after the removal of a right frontal meningioma, an intracrauial hemorrhage occurred during the act of straining at stool. Postoperative angiography revealed a "pea-sized" saccular aneurysm of the middle cerebral artery, close to the site of application of a silver clip. The author considered this to be a false aneurysm. The application of a second silver clip to the neck of the sac resulted in the patient's recovery. Taylor, 5 in 1961, found reports of 7 cases in the literature of the previous 65 years, and analyzed 8 unreported cases from the files of the Atkinson ]VIorley's Hospital, Wimbledon, and the National Hospital, Queen Square, London, which, with the addition of a patient observed by him, totaled 9 cases of intracranial aneurysm associated with primary tumor. In 2 of the 9 patients, bleeding occurred preoperatively; in 3, postoperatively. In 1, the aneurysm bled but no operation was performed; and in 3 no bleeding occurred. Eight of the 9 aneurysms were considered to be "developmental" in origin; the origin of 1 was "uncertain". The decompression resulting from removal of the tumor was considered in some way to be a factor accelerating aneurysmal dilatation and early hemorrhage from a pre-existing developmental lesion. Boldrey 1 observed a ruptured aneurysm in a patient who had had a previous operation for meningioma. The patient died of subarachnoid hemorrhage. The amount of recurrent meningioma was not significant.

Four patients undergoing cervical spinal manipulations for nonneurologic diseases and with no previous neurologic signs or symptoms all developed significant neurologic deficits, one fatal, following manipulations of the cervical spine. Both the literature and the authors' series show that a number of patients have a prodrome prior to the onset of neurologic changes. There is no established therapy for the syndrome. Perhaps prevention is the best means of reducing neurologic injury.