Occult falcine meningioma unmasked following nearly complete hemorrhagic transformation with resultant spontaneous acute interhemispheric subdural hematoma

Abstract

Sudden-onset monoplegia with features of vomiting and headache usually signals an intracranial cerebrovascular event. We describe a 62-year-old man in whom this presentation was the result of the rare occurrence of an almost complete hemorrhagic transformation of a falcine meningioma with resultant acute interhemispheric subdural hematoma, and discuss the risk factors and possible mechanisms that may lead to such an event. The need for careful examination of the available radiology and aggressive tumor removal is stressed.

Tiny Falx Meningioma Causing Massive Interhemispheric Subdural Hematoma: A Case Report

“… 2 – 4) Subdural hemorrhage is uncommon: especially acute or subacute interhemispheric subdural hematoma is rare, and only four cases were reported including our case ( Table 1 ). 7 – 9) To be associated with interhemispheric subdural hematoma, meningioma should be located in a parasagittal region or on the falx. 7 – 9) The tumor histology was diverse and a half of cases were accompanied by intratumoral hematoma.…”

“… 7 – 9) To be associated with interhemispheric subdural hematoma, meningioma should be located in a parasagittal region or on the falx. 7 – 9) The tumor histology was diverse and a half of cases were accompanied by intratumoral hematoma. 7 – 9) The surgical outcome was excellent in all cases.…”

“… 7 – 9) The tumor histology was diverse and a half of cases were accompanied by intratumoral hematoma. 7 – 9) The surgical outcome was excellent in all cases. The preoperative identification of a previously unsuspected small meningioma with a nearly complete hemorrhagic transformation may be difficult like in our case.…”

“…There are three reported cases of falx meningioma presenting as acute or subacute subdural hematoma, 5 – 7) but only one case was associated with interhemispheric subdural hematoma. 7) This means that even falx meningioma tends to cause non-interhemispheric subdural hematoma, although the reason is unknown. On the other hand, three cases of meningiomas associated with acute subdural hematoma could not be detected on admission CT like in our case.…”

“… 2 – 4) Subdural hemorrhage from meningiomas is uncommon, especially along the falx. 5 – 7) We here report a rare case of tiny falx meningioma presenting as massive interhemispheric subdural hematoma, initially of unknown origin, and review the literature.…”