Misdiagnosis and Delay of Diagnosis in Hemorrhagic Meningioma: A Case Series and Review of the Literature

Huang, Ruibin; Chen, Liujiang; Su, Shuyan; Wu, Xiaojia; Zheng, Yungui; Wang, Huan-Peng; Zhuang, Ruyao; Liu, Yuan

doi:10.1016/j.wneu.2021.09.020

Cited by 7 publications

(9 citation statements)

References 38 publications

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“…As this condition is rare, the determination of causative factors for the hemorrhage is difficult, and it is not as easy to understand the mechanisms of spontaneous hemorrhage (11,15,16). Cases of spontaneous hemorrhage in meningioma have been sporadically reported, however, and a number of clinical features of the condition have been characterized (4)(5)(6)(7)10,11,(16)(17)(18).…”

Section: Discussionmentioning

confidence: 99%

“…The exact mechanism of the hemorrhage from meningiomas is not fully understood; however, several pathological mechanisms have been considered in the explanation of this rare condition. The proposed mechanisms include weakened blood vessel rupture, endothelial proliferation and resultant vascular occlusion, direct tumor cell invasion of the vasculature, bioactive substance accumulation in the tumor, concomitant vascular malformation or aneurysm, stretching and rupture of subdural bridging veins, venous compression induced by tumor growth and associated with peritumoral edema, and infarction due to rapid tumor growth (2)(3)(4)(5)(6)(8)(9)(10)(11)(16)(17)(18). In addition, two specific types of blood vessels, differentiated and undifferentiated vessels, were found in our prior study; undifferentiated blood vessels contribute to a fragile tumor vasculature, which a precipitating event may disrupt, thus resulting in a spontaneous hemorrhage (11).…”

Section: Discussionmentioning

confidence: 99%

“…Although CT is the reference standard for the detection of hemorrhage, meningioma with intracranial hemorrhage is not always easy to distinguish on CT, and multi-model radiological examinations are needed ( 11 ). Brain CT and MRI usually display dense, well-defined, contoured extra-axial masses that displace the adjacent brain along with acute or subacute hemorrhage ( 3 , 6 ). The site of the hematoma does not typically exhibit hypertensive intracerebral bleeding, and it is usually away from the center of the cerebral parenchyma ( 3 ).…”

Section: Discussionmentioning

confidence: 99%

“…While no difficulty is encountered in the diagnosis of a hemorrhage in a previously known brain tumor, hemorrhagic onset as the initial presentation of a brain tumor may pose diagnostic problems (6). Meningiomas with hemorrhagic onset can manifest in several ways and some of the clinical features of such a condition have been characterized; however, previous studies regarding this condition have been limited to single-case reports or small case series (2,4,(7)(8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

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Radiological classification of meningiomas with hemorrhagic onset and its clinical significance

et al. 2022

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Meningiomas are the most common benign intracranial tumors and frequently present with a gradual onset of neurological deficits; conversely, their acute presentation with hemorrhagic onset appears to be a rare event. Nonetheless, as early surgical evacuation is the foundation of treatment, a timely diagnosis of this rare type of intracranial hemorrhage is necessary. The purpose of the present single-center study was to investigate the radiological characteristics and propose a new bleeding classification for guiding the diagnosis and treatment. A total of 19 patients consecutively diagnosed with hemorrhagic meningioma were enrolled in this retrospective study. Intracranial extra-axial mass, tumor-associated hemorrhage and peritumoral brain edema were the three main radiological features of the hemorrhagic meningiomas. The site of tumor-associated hemorrhage included the peritumoral space, subarachnoid space, subdural space, brain parenchyma and/or intratumor region. Based on the anatomical relationship between meningioma and hematoma, the spontaneous hemorrhage stemming from meningiomas was further summarized into three bleeding patterns involving purely intratumoral hemorrhage (type I), purely extratumoral hemorrhage (type II) and combined intra/extratumoral hemorrhage (type III); furthermore, the type III hemorrhage usually came from type I bleeding that extended into the surrounding regions. The symptoms in type I patients were generally mild and early surgery was performed following adequate preoperative evaluations. The symptoms in type II patients were mild in certain cases and moderate to severe in others, so early or emergency surgery was chosen according to the clinical status of the patient. Almost all type III patients had moderate to severe symptoms and these patients usually required emergency surgery. In addition, patients with different bleeding types may have different pathological mechanisms underlying the tumor bleeding. Apart from being convenient for diagnosis, this concise and practical bleeding classification may aid in the selection of the treatment strategy and facilitate the understanding of the associated mechanisms.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Radiological classification of meningiomas with hemorrhagic onset and its clinical significance

et al. 2022

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“…Conscious patients with early recognized hemorrhagic meningioma who underwent resection had a 96.2% survival rate [2]. In a very recently published article, the authors concluded that hemorrhagic meningiomas can be missed or misdiagnosed, while the main misdiagnoses were subdural hematoma (27.3%) and traumatic hematoma (13.6%) [12]. Our patient presented with right temporal IPH, bilateral SDH, and extensive vasogenic edema in the right temporal lobe that warranted brain MRI with and without contrast and lead to the discovery of the underlying lesion.…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Life-Threatening Multicompartmental Spontaneous Intracranial Hemorrhage From a Grade 1 Convexity Meningioma

Abolfotoh¹,

Brzezicki²,

Fiester³

et al. 2021

Cureus

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Meningiomas are slowly growing benign tumors. The incidence of hemorrhage associated with intracranial meningiomas is in the 0.5%-2.4% range. However, intracranial meningiomas with hemorrhagic presentation are associated with higher rates of overall major morbidity (36%) and mortality (21.1%). We report a case of a convexity meningioma presenting with intraparenchymal hematoma and bilateral acute subdural hematomas (SDH) in a comatose patient (Glasgow Coma Scale (GCS) score: 7) who had a history of recurrent episodes of headaches over the past few months. Hemorrhagic presentation of a meningioma is a rare but potentially devastating event. Early recognition of the potential underlying meningioma as a cause of bleeding followed by rapid appropriate additional imaging is crucial to direct treatment plans to achieve the best outcome.

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Meningioma presenting with hemispheric acute subdural Hematoma: A review of the literature

Mazengia Andualem,

Gebeyehu Shiferaw,

Asimare Emiru

et al. 2023

Interdisciplinary Neurosurgery

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Misdiagnosis and Delay of Diagnosis in Hemorrhagic Meningioma: A Case Series and Review of the Literature

Cited by 7 publications

References 38 publications

Radiological classification of meningiomas with hemorrhagic onset and its clinical significance

Radiological classification of meningiomas with hemorrhagic onset and its clinical significance

A Rare Case of Life-Threatening Multicompartmental Spontaneous Intracranial Hemorrhage From a Grade 1 Convexity Meningioma

Meningioma presenting with hemispheric acute subdural Hematoma: A review of the literature

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