Peritumoural haematoma and meningioma: a common tumour with an uncommon presentation

Kouyialis, Andreas T.; Stranjalis, George; Analyti, R.; Boviatsis, E.J.; Korfias, Stefanos; Sakas, Damianos E.

doi:10.1016/j.jocn.2004.02.014

Cited by 10 publications

(10 citation statements)

References 14 publications

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“…Meningiomas are usually benign tumors that arise from arachnoidal cap cells and are detected by the symptoms caused by increased intracranial pressure and seizures. Progressive neurological deficits may also occur, depending on the tumor location and growth (16). Hemorrhagic meningioma is a rare disease with an incidence of 2.0-2.2% in Asia in the last two decades (6,7).…”

Section: Discussionmentioning

confidence: 99%

Continuous progression of hemorrhage of sphenoid ridge meningioma causing cerebral hernia: A case report and literature review

Han

Yang

et al. 2020

Oncol Lett

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The aim of the present study was to explore the clinical characteristics of repeated hemorrhages of meningioma and analyze the causes of hemorrhage. Meningiomas are mostly benign tumors that rarely manifest hemorrhagic strokes. In the present study, a case of sphenoid ridge meningioma with repeated hemorrhages is reported. Internal hemorrhage was first observed, which, on further aggravation, formed a hematoma in the brain parenchyma and finally led to the development of a hernia. No neurological deficit was present after surgery and rehabilitation. A postoperative pathological examination showed increased levels of Ki-67, abnormal blood vessels in the tumors and the presence of progesterone, which indicate possible causes of the hemorrhage. A review of associated previous studies revealed that hemorrhages originate mainly from inside the meningioma. Two cases of meningiomas with repeated hemorrhages have been reported; one in the foramen magnum region and the other in the pineal gland area. The foramen magnum tumor had an interval of 1.33 months between two hemorrhagic episodes. Collecting relevant data from the latter case was not possible. In the present case report, the interval between two bleeding episodes was 3 days. The literature review also revealed that the average age of onset of meningioma is relatively young at only 28.00±6.24 years. In conclusion, repeated hemorrhages in meningiomas are extremely rare and the causes have not yet been identified. Increased Ki-67 and abnormally proliferating blood vessels may be potential causes of hemorrhage. Early diagnosis and rapid surgical intervention are essential to prevent further episodes of bleeding, which may otherwise have fatal consequences for the patients.

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Section: Discussionmentioning

confidence: 99%

Continuous progression of hemorrhage of sphenoid ridge meningioma causing cerebral hernia: A case report and literature review

Han

Yang

et al. 2020

Oncol Lett

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“…The underlying pathophysiologic mechanisms have been subject to several studies, although it remains unclear as to the reason why and which under the circumstances some meningiomas bleed. [ 15 ] Accepted to date theories suggest that rupture of tumor vessels, tumor growth causing subdural bridging vein rupture, rapidly expanding tumors, tumor cells invading and disrupting blood vessels and tumor-derived vasoactive substances could lead to tumor bleeding. [ 1 , 2 , 8 ] Nevertheless this still does not explain why this is such a rare event, since most meningiomas we see in our daily practice do not follow this course.…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 , 2 , 8 ] Nevertheless this still does not explain why this is such a rare event, since most meningiomas we see in our daily practice do not follow this course. [ 15 , 28 ] It is accepted that several mechanisms might simultaneously be involved in the development of hemorrhage. [ 4 ]…”

Section: Discussionmentioning

confidence: 99%

Meningioma-related subacute subdural hematoma: A case report

Matos

Pereira

2020

Surgical Neurology International

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Background: Meningiomas are the most frequent benign head tumors, although spontaneous hemorrhage is a rare form of presentation of such lesions. Of all possible bleeding locations associated with them, the subdural space is one of the most uncommon, with very few cases reported worldwide. Case Description: A middle-aged woman presented with progressively worsening left-sided headache, initiated 2 weeks before, with no other complaints, denying any previous head trauma. Head computed tomography revealed a subacute left hemisphere subdural hematoma and left frontal, suggestive of meningioma on magnetic resonance imaging. Surgical treatment was performed with hematoma evacuation and lesion removal. Neuropathology showed a transitional meningioma with signs of hemorrhage. After surgery, no neurological deficits were registered, and headache abated. Conclusion: As we could not identify any other cause for the subacute subdural hematoma, hemorrhage from the meningioma was the most probable cause, and thus, we decided to remove it along with clot evacuation. Based on neuropathological findings, we propose an alternative mechanism for this spontaneous hemorrhage from the meningioma, involving the place where the periphery of the lesion insertion, the dura mater as the origin of the hemorrhage. Knowledge of this association could help define the best treatment in such cases.

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“…According to previously reported cases, the incidence ranges from 0.5-2.4% (3). Although rare, intracranial hemorrhage stemming from meningioma could have a detrimental effect on outcomes and may even be a life-threatening event due to acutely increased intracranial pressure (2)(3)(4). Cheng and Lin (5) reported that the mortality rate associated with hemorrhagic meningiomas was as high as 38.5% in the CT era and 77.8% in the era before CT. Boŝnjak et al (2) reported overall mortality and morbidity rates of 21.1 and 32.6%, respectively, for hemorrhagic meningiomas in 2005.…”

Section: Introductionmentioning

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). The cases in the literature were reported according to the site of hemorrhage such as the subarachnoid space (8), subdural space (7,9), peritumoral space (4), brain parenchyma (2,10) or intratumor region (11,12).…”

Section: Introductionmentioning

confidence: 99%

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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Peritumoural haematoma and meningioma: a common tumour with an uncommon presentation

Cited by 10 publications

References 14 publications

Continuous progression of hemorrhage of sphenoid ridge meningioma causing cerebral hernia: A case report and literature review

Continuous progression of hemorrhage of sphenoid ridge meningioma causing cerebral hernia: A case report and literature review

Meningioma-related subacute subdural hematoma: A case report

Radiological classification of meningiomas with hemorrhagic onset and its clinical significance

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