Primary brain tumour presenting as spontaneous intracerebral haemorrhage

Abstract

In an autopsy series of 430 spontaneous intracerebral haematomas 44 cases, or 10.2 percent, were caused by a proved neoplasm, including 21 anaplastic gliomas, 17 metastases, 2 oligodendrogliomas, 2 malignant lymphomas, and one meningioma. These instances of massive bleeding into brain tumour represented 2.4 percent of about 1,800 primary and secondary cerebral neoplasms proved by necropsy. In only four of the patients with primary brain tumours (two glioblastomas, one oligodendroglioma invading the leptomeninges, and one primary malignant lymphoma), three of them with a history of arterial hypertension, were the presenting symptoms these of a spontaneous intracerebral haemorrhage, and the tumour itself was not diagnosed until surgery or necropsy. One patient with acute haemorrhage into a glioblastoma of the basal ganglia showed a rapidly lethal course, while the others demonstrated one or more episodes before the onset of the acute fatal illness and a prolonged period from the time of the bleed until death. The clinical features and the pathogenesis of spontaneous haemorrhage into cerebral neoplasms are briefly reviewed.

Posttransplant primary CNS lymphoma

“…Delayed hemorrhage at the biopsy site and hemorrhage at other sites, as in one of our patients, suggest that it may be a characteristic of PT-PCNSL rather than a fault of the biopsy technique. There are reports of hemorrhage, before treatment, in PCNSL associated with acquired immunodeficiency syndrome and rare reports of hemorrhage in PCNSL in immunocompetent patients and as a late complication after treatment of childhood CNS lymphoma (Claviez et al, 1998;Fukui et al, 1998;Kothbauer et al, 1979;Poussaint et al, 1995;Zimmerman and Bilaniuk, 1980). However, no predictive characteristics, either of the patient or of the neuro-imaging features, were identi ed to guide biopsy.…”

Pontine Malignant Astrocytoma With Hemorrhagic Onset-Case Report-

“…12,14,18) However, these cases were not associated with hemorrhage on CT. Only three of 1861 brain tumors were pontine gliomas associated with hemorrhage. 20) Pontine gliomas associated with hemorrhage identified by neuroimaging 7,11,20) or histological study 9) may not be very rare, but our case of pontine glioma associated with massive hemorrhage also presented with unusual stroke-like onset.…”

“…1,8,20) Excluding pituitary adenoma, the incidence of hemorrhage from brain tumor was 2.4-5.4% macroscopically 1,8,9,20) and 9.2% microscopically. 8) The incidence of hemorrhage in pediatric patients was higher, at 5.3% 20) and 10%, 13) respectively, than in adults.…”

Midbrain and thalamic haemorrhage as first presentation of intracerebral glioma

“…19 Another autopsy series of 430 spontaneous intracerebral haematomas found that 21 out of 44 tumour-associated haematomas were anaplastic glioma, 17 associated with metastatic tumour, 2 with oligodendrogliomas, 2 malignant lymphomas and one meningioma. 15 The proposed underlying pathology of the tumour-related haemorrhages include abnormal vascular proliferation with thin walled and poorly formed blood vessels, high grade malignancy with vascular invasions, preexisting hypertension and radiation therapy. 22,23 Diagnosing a brain tumour in the presence of a massive intracerebral haemorrhage is difficult.…”

“…The incidence of tumour-related intracerebral haemorrhage has varied between different studies, ranging from 0.6%, with most at about 5%, to one as high as 10.2%. [11][12][13][14][15][16][17][18][19] Approximately 3% of patients with an admission diagnosis of stroke have been subsequently demonstrated to have a tumour. 20 Reviewing all brain tumours which have had spontaneous haemorrhage, the haemorrhage was the initial presentation of previously unknown tumour in 33% to 60% of cases.…”