Lipomatous Meningioma With Concomitant Acute Subdural Hematoma -Case Report-

Abstract

A 55-year-old man presented with a rare lipomatous meningioma associated with acute subdural hematoma manifesting as sudden onset of severe headache, but no neurological deficit. No evidence of trauma or underlying predisposition to hemorrhage was seen. Fluid-attenuated inversion-recovery magnetic resonance imaging showed a thin hyperintense area in the right temporal convexity, and an extra-axial mass appearing as mixed hypointensity and hyperintensity. Two weeks later, right temporal craniotomy was performed and the tumor was totally resected with the attached dura. The hematoma was localized at the inferior margin of the mass and connected directly with the tumor. Histological examination of the resected specimen revealed typical meningothelial meningioma admixed with mature adipose tissue. Longstanding intratumoral congestion probably caused hyaline deposition in the tissue, leading to vessel rupture.

Recurrent acute subdural bleeding as a rare complication of a hemorrhagic non malignant meningioma.

“…Kashimura et al (10) adhered to this hypothesis, but for Worm et al (11) histological grading of the tumors failed to reveal significant relationship with hemorrhagic events.…”

“…Several hypotheses have been proposed to explain spontaneous hemorrhage associated with intracranial meningioma (10,11), e.g. rupture of abnormal tumor vessels, vaso-active substances released by meningiomas, venous thrombosis leading to tumor necrosis or rapid tumor growth leading to stretching of subdural bringing veins and their rupture after minor trauma.…”

Hemorrhagic onset of cerebellar pilocytic astrocytoma in an adult: a case report and review of the literature implying a possible relation of degenerative vascular changes to the massive intratumoral hemorrhage

“…It is uncertain whether the process of pituitary apoplexy is primary hemorrhage or hemorrhagic infarction. On the other hand, possible causes of intra-and peritumoral hemorrhage in meningiomas include aneurysm rupture in feeding arteries, abundant vasculature in angiomatous type, and stretching of the subdural bridging vein [33][34][35].…”

Lipomatous meningioma: A study of five cases with brief review of literature

“…[1] Lipomatous meningioma, also known as lipomeningioma or lipoblastic meningioma, is a rare entity and only 36 cases have been described in the English literature. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] The largest series included 18 cases [3] and ours is probably the second largest series of lipomatous meningioma. Lipomatous meningiomas represented 0.3% of all meningiomas operated at the Mayo Clinic over 15 years period.…”

“…[3,4] The studies on lipomatous meningioma are limited, and only 36 cases have been described in the literature. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] In this study, we describe the clinical course, neuro-radiological features and morphology of 5 patients with lipomatous meningioma.…”