Brain Tumor Res Treat.  2015 Apr;3(1):30-33. 10.14791/btrt.2015.3.1.30.

A Case of Benign Meningioma Presented with Subdural Hemorrhage

• Kim JH
• Gwak HS
• Hong EK
• Bang CW
• Lee SH
• Yoo H

• KMID: 1882007
• DOI: http://doi.org/10.14791/btrt.2015.3.1.30

Abstract

Meningiomas are the most common benign intracranial tumors and make up 13-26% of all primary intracranial tumors. Clinical presentation of hemorrhage is rare in these tumors occurring in approximately 1.3% of cases and subdural hemorrhages are even more uncommon. The mechanism of hemorrhage is still unclear and may vary according to histologic type, location and the type of hemorrhage. We experienced a case of 61-year-old woman with a benign meningioma presenting as a subdural hemorrhage. She developed sudden onset of headache right after aggressively coughing. Her headache persisted for a week before she was admitted to the emergency room of National Cancer Center. She had a past medical history of ovarian cancer which had been treated and was allegedly recurrence-free for 2 years. At the time of admission, a headache was the only symptom and imaging studies showed a right frontal hemorrhagic subdural mass lesion accompanying an ipsilateral subdural hematoma. Elective surgery was performed and intraoperative findings revealed the hallmark characteristics of a meningioma with mixed stage diffuse subdural hematoma. Permanent pathology result determined it was a conventional meningioma (World Health Organization grade I). From this case, we discuss the rare presentation of subdural hemorrhage in meningioma and related points by reviewing the literature of previous studies.

Keyword

Meningioma; Benign neoplasm; Hemorrhage; Hematoma, subdural

MeSH Terms

Cough
Emergency Service, Hospital
Female
Headache
Hematoma, Subdural*
Hemorrhage
Humans
Meningioma*
Middle Aged
Ovarian Neoplasms
Pathology
World Health Organization

Figure

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  Fig. 1 Neuroimaging studies. A: CT scan. A mass lesion with diameter of 5 cm in right frontal area showing conglomerated high density and cresenteric low density lesion abutting to the mass in ipsilateral subdural area. Magnetic resonance images. B: T1-weighted image. A central portion of iso-to-high signal intensity and cresenteric subdural lesion of low signal intensity. C: T2-weighted image. A central low signal intensity and cresenteric high signal intensity. D: Gadolinium enhancement. Mass showing strong homogenous enhancement except central portion.

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  Fig. 2 Intraoperative photography. A: After reflection of dura, acute and subacute subdural hemorrhage over brain surface appears. B: Acute subdural hematoma extended from the tumor into subdural space (black arrow). C: At the bottom of tumor, tumor capsule is attached to pial surface and cortical vein (arrowheads). D: A membrane surrounding chronic subdural hematoma is caught at the end of suction tip.

• 

  Fig. 3 Pathological finding of surgical specimen. A: The tumor shows conventional meningioma of fibrous type (H&E, ×100). B: The blood vessels in higher magnification show thin-walled, branching or arborizing capillaries with clear, empty lumen. The stroma is edematous. Multifocal intratumoral hemorrhage (upper left) are noted (H&E, ×100).

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