Intracerebral Hemorrhage Secondary to Solitary Fibrous Tumor: A Case Report

Solitary fibrous tumors (SFTs) of the central nervous system are uncommon mesenchymal neoplasms that may remain clinically silent until they reach a significant size or produce neurological manifestations. Although these tumors are typically slow-growing, they can occasionally present with acute neurological deterioration when associated with intracerebral hemorrhage. Such presentations are uncommon and can make diagnosis and management particularly challenging. We report the case of a 46-year-old woman with no previous medical history who experienced sudden-onset severe headache, vomiting, and rapid neurological decline, ultimately requiring emergent airway protection. On arrival, she presented with a markedly depressed level of consciousness, anisocoria, absent pupillary responses, and severe hypertension. Brain computed tomography (CT) revealed a large left fronto-temporo-parietal intracerebral hematoma producing mass effect and midline shift. The patient underwent emergency decompressive craniectomy with evacuation of the hematoma, during which an underlying tumor was identified and completely resected. Histopathological examination demonstrated a collagen-rich lesion composed of cellular nodules with elevated mitotic activity, without necrosis or marked atypia. Immunohistochemical staining showed strong nuclear STAT6 expression, supporting the diagnosis of SFT. This case illustrates the potential for SFTs to present with acute intracerebral hemorrhage, leading to abrupt clinical deterioration. The hemorrhagic event likely contributed to the patient's severe neurological status at admission and prompted urgent surgical intervention. Complete resection was feasible and allowed for histological diagnosis.  Given the possibility of delayed recurrence and the unpredictable behavior of these tumors, long-term postoperative surveillance remains essential. This case highlights the importance of considering underlying neoplasms in spontaneous intracerebral hemorrhage and emphasizes the role of timely surgical management in improving diagnostic accuracy and clinical outcomes.