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Meningioma-related subacute subdural hematoma: A case report
Daniela Matos1, Ricardo Pereira1,2
1Department of Neurosurgery, Coimbra University Hospital Centre, Portugal.
Background:
Meningiomas are the most frequent benign head tumors, although spontaneous hemorrhage is a rare form of presentation of such lesions. Of all possible bleeding locations associated with them, the subdural space is one of the most uncommon, with very few cases reported worldwide.
Case Description:
A middle-aged woman presented with progressively worsening left-sided headache, initiated 2 weeks before, with no other complaints, denying any previous head trauma. Head computed tomography revealed a subacute left hemisphere subdural hematoma and left frontal, suggestive of meningioma on magnetic resonance imaging. Surgical treatment was performed with hematoma evacuation and lesion removal. Neuropathology showed a transitional meningioma with signs of hemorrhage. After surgery, no neurological deficits were registered, and headache abated.
Conclusion:
As we could not identify any other cause for the subacute subdural hematoma, hemorrhage from the meningioma was the most probable cause, and thus, we decided to remove it along with clot evacuation. Based on neuropathological findings, we propose an alternative mechanism for this spontaneous hemorrhage from the meningioma, involving the place where the periphery of the lesion insertion, the dura mater as the origin of the hemorrhage. Knowledge of this association could help define the best treatment in such cases.
Insights
Spontaneous subdural hematoma from a meningioma is rare. Surgical removal of the meningioma and hematoma resolved symptoms, suggesting this as a viable treatment for this uncommon presentation.
Area of Science:
- Neurosurgery
- Neuropathology
Background:
- Meningiomas are common benign brain tumors.
- Spontaneous hemorrhage is a rare presentation.
- Subdural bleeding from meningiomas is exceptionally uncommon.
Observation:
- A middle-aged woman presented with a two-week history of worsening headache.
- CT revealed a subdural hematoma; MRI suggested a frontal meningioma.
- Surgical intervention included hematoma evacuation and meningioma removal.
Findings:
- Neuropathology confirmed a transitional meningioma with hemorrhage.
- The patient experienced complete headache resolution and no neurological deficits post-surgery.
- Hemorrhage likely originated from the meningioma's dural insertion site.
Implications:
- Hemorrhage from meningioma is a plausible cause of spontaneous subdural hematoma.
- Surgical resection of the meningioma is an effective treatment.
- Understanding hemorrhage mechanisms aids in managing these rare cases.
