Vestibular schwannoma with repeated intratumoral hemorrhage

A symptomatic hemorrhage from a vestibular schwannoma is extremely rare, despite its relatively high incidence in the cerebellopontine angle. Much more unusual are repeated intratumoral hemorrhages. The authors report on such a rare case of repeated intratumoral hemorrhage from a vestibular schwannoma, presenting with sudden exacerbation of headache, nausea and vomiting. This second hemorrhage was confirmed by CT scan on the day of the onset of symptomatic exacerbation, which was 9 days after the initial CT scan, showing an enlarged amount of blood within the tumor. The MRI scan confirmed this CT finding. After removal, the tumor proved to be a typical vestibular schwannoma of mixed Antoni types A and B. Thin-dilated vessels with hemorrhage and hemosiderin-laden macrophages were observed. The patient's postoperative course was uneventful. A total of 28 reported cases of a single intratumoral hemorrhage in vestibular schwannomas, and one reported case of repeated hemorrhage are reviewed.