Massive intracranial hemorrhage associated with pleomorphic xanthoastrocytoma--case report

A 60-year-old woman with a history of intermittent headaches and frequent seizures for 30 years presented with a massive intracranial hematoma in the left medial temporal lobe with thick subarachnoid hemorrhage. She had been treated with anticonvulsant medication under a diagnosis of left mesial temporal sclerosis based on magnetic resonance imaging findings. Cerebral angiography on admission revealed occlusion of the P(2) segment of the left posterior cerebral artery (PCA) and extravasation of contrast medium during the procedure. The patient underwent left temporal lobectomy including the lesioned mesial temporal cortex, and the ruptured P(2) segment of the PCA was removed as well. The operative finding of the ruptured aneurysm was pseudoaneurysm. Histological examination of the resected PCA segment demonstrated a pleomorphic xanthoastrocytoma invading the outer wall of the PCA. Presumably the bleeding was caused by the rupture of a pseudoaneurysm secondary to leptomeningeal involvement of this typically benign tumor.