Spinal subarachnoid hemorrhage associated with leptomeningeal metastases

Retrospective evaluation of 120 patients treated for leptomeningeal metastases at the Hadassah Hebrew University Hospital disclosed 3 patients with spontaneous spinal subarachnoid hemorrhage (SAH) occurring in the absence of bleeding tendency. These patients are described in detail. A search of the English literature revealed only 2 additional cases. The primary neoplasm originated in the central nervous system in 4 of these 5 patients; a resection of an intraparenchymal posterior fossa tumor antedated the development of subarachnoid seeding in 3 of the 5 patients; SAH occurred in face of a negative CSF cytology and in the presence of macroscopic subarachnoid deposits that were diagnosed with the aid of neuroimaging techniques. It is suggested that spontaneous spinal SAH in a patient with a history of primary or secondary brain tumor and with no bleeding tendency indicates probable presence of macroscopic leptomeningeal deposits.