Pleomorphic xanthoastrocytoma presenting with massive intracranial hemorrhage

A 46-year-old woman presented with massive left temporal lobe intraparenchymal and diffuse subarachnoid hemorrhage on CT. Lack of enhancement excluded intermediate and high-grade primary tumor or metastasis as likely causes. At surgery, a fibrovascular left temporal lobe mass adherent to the dura proved to be a pleomorphic xanthoastrocytoma. The unusual hemorrhagic presentation of this typically benign entity is thought to be related to the meningeal involvement, which itself is characteristic of this neoplasm.