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Falx meningioma presenting as acute subdural hematoma: case report
Background:
Acute subdural hematomas caused by meningiomas have been rarely encountered. Pathophysiologic mechanisms and clinical considerations in these patients have not been sufficiently explored. We addressed the possible mechanism of spontaneous hemorrhage in our case and briefly discuss the optimal treatment.
Case Description:
This case of falx meningioma presenting as an acute subdural hematoma in a 78-year-old woman is described. On initial computed tomography (CT), an enhancing tumor of the falx appeared to be the cause of hemorrhage. Only faint contrast staining in the periphery of the tumor was seen on right external carotid arteriograms, with no evidence of other vascular supply. Extravasation of contrast material during the procedure occurred suddenly and was successfully treated by endovascular embolization using a microcatheter. The hematoma was emergently evacuated with gross total removal of the tumor. Pathologic examination confirmed a transitional meningioma with abundant hyalinized structures. Disruption of a thin-walled vessel adjacent to the tumor capsule was assumed to be the site of hemorrhage.
Conclusions:
The longstanding ischemia of the tumor was considered to have produced the deposition of hyalin in the tissue, which changed the hemodynamics within the tumor, producing vascular stress leading to rupture. The prognosis of patients with meningiomas complicated by acute subdural hematoma is generally poor, with mortality reported in approximately one-half of such patients. Surgical exploration is the most effective treatment and should be conducted before irreversible brain damage has occurred.
Insights
Acute subdural hematoma from meningioma is rare. This case suggests tumor ischemia caused hyaline deposition, leading to vascular rupture and hemorrhage, necessitating prompt surgical intervention.
Area of Science:
- Neurosurgery
- Neuropathology
Background:
- Acute subdural hematoma (ASH) is a rare complication of meningioma.
- Understanding the pathophysiology and clinical management of meningioma-associated ASH is crucial.
Observation:
- A 78-year-old woman presented with ASH due to a falx meningioma.
- Initial CT revealed an enhancing falx tumor as the hemorrhage source.
- Arteriography showed minimal tumor vascularity, with sudden contrast extravasation treated by embolization.
Findings:
- Pathology confirmed a transitional meningioma with hyalinized structures.
- Hemorrhage was attributed to the rupture of a thin-walled vessel adjacent to the tumor capsule.
- Tumor ischemia likely led to hyaline deposition, altering hemodynamics and causing vascular stress.
Implications:
- Meningiomas complicated by ASH have a poor prognosis, with high mortality rates.
- Prompt surgical evacuation of the hematoma and tumor removal is critical to improve outcomes.
- Early surgical intervention is recommended before irreversible brain damage occurs.