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A Murine Model of Subarachnoid Hemorrhage
Published on: November 21, 2013
Intratumoral Hemorrhage within Petrous Meningioma
Pouya Entezami1, Alexander Riccio1, Tyler J Kenning1
1Department of Neurosurgery, Albany Medical College, Albany, New York, USA.
Background:
Intracranial hemorrhage stemming from a benign intracranial lesion is much less commonly seen than from malignant tumors such as gliomas or metastases. Cerebellopontine angle (CPA) lesions rarely present with hemorrhage.
Case Description:
We describe the case of a 49-year-old male with a recurrent right CPA meningioma arising from the petrous bone that was previously treated with a subtotal resection and postsurgical radiosurgery, presenting with acute left-sided hemiparesis secondary to intratumoral hemorrhage. Although surgical evacuation and decompression were recommended, the patient declined operative intervention and was managed medically.
Conclusions:
Meningiomas can cause subarachnoid, intraparenchymal, and rarely intratumoral hemorrhage. Symptomatic hemorrhage can worsen the prognosis, with increased morbidity and mortality. Several etiologies have been proposed for this phenomenon including rupture of aberrant vasculature, intratumoral necrosis, and tearing of stretched bridging veins. Only 2 prior cases of CPA meningioma have been reported in the literature. Recognition of CPA meningioma hemorrhage as a clinical entity can help in future diagnoses and management.
Insights
Intracranial hemorrhage from a benign cerebellopontine angle meningioma is rare. This case highlights intratumoral hemorrhage in a recurrent meningioma, emphasizing the need for clinical recognition.
Area of Science:
- Neurosurgery
- Neurology
- Oncology
Background:
- Intracranial hemorrhage is more commonly associated with malignant brain tumors than benign lesions.
- Cerebellopontine angle (CPA) lesions rarely present with hemorrhage.
Observation:
- A 49-year-old male presented with acute left-sided hemiparesis due to intratumoral hemorrhage within a recurrent right CPA meningioma.
- The meningioma had a history of subtotal resection and postsurgical radiosurgery.
- The patient opted for medical management over surgical evacuation and decompression.
Findings:
- Meningiomas can manifest as subarachnoid, intraparenchymal, or, rarely, intratumoral hemorrhage.
- Proposed causes include aberrant vasculature rupture, intratumoral necrosis, or venous tearing.
- Only two previous cases of CPA meningioma hemorrhage have been documented.
Implications:
- Symptomatic hemorrhage from meningiomas can significantly increase morbidity and mortality.
- Recognizing CPA meningioma hemorrhage as a distinct clinical entity is crucial for accurate diagnosis.
- This case underscores the importance of considering rare presentations of common tumors for improved patient outcomes.
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