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Meningioma associated with acute subdural hematoma--case report
I Sunada1, H Nakabayashi, Y Matsusaka
1Department of Neurosurgery, Saiseikai Ibaraki Hospital, Osaka, Japan.
Abstract:
A 48-year-old woman presented with sudden left hemiplegia with headache, which deteriorated two days later. CT scan showed repeated intratumoral and subdural hemorrhages. Magnetic resonance imaging showed a parasagittal tumor infiltrating into the superior sagittal sinus, with intratumoral hemorrhage and acute subdural hematoma in the interhemispheric fissure. The intratumoral hematoma had several different intensities, which indicated repeated hemorrhages. The subdural hematoma and the tumor were removed via frontoparietal craniotomy. The histological diagnosis was fibrous-type meningioma with a high Ki-67 labeling index (6.7). As there were tumor cells within the subdural hematoma, it seemed to have resulted from tumoral hemorrhage. A high index of cell proliferation may indicate some mechanism responsible for hemorrhage in malignant tumor.
Insights
A brain tumor caused repeated bleeding into itself and the surrounding area, leading to stroke symptoms. High cell proliferation in the fibrous meningioma may explain the hemorrhage.
Area of Science:
- Neurology
- Neurosurgery
- Oncology
Background:
- Meningiomas are typically benign tumors, but some subtypes can exhibit aggressive behavior.
- Intracranial hemorrhage is a rare but serious complication of meningiomas.
Observation:
- A 48-year-old woman presented with sudden hemiplegia and headache, indicative of a stroke.
- Imaging revealed a parasagittal tumor with intratumoral and subdural hemorrhages, suggesting repeated bleeding events.
- Histological analysis identified a fibrous meningioma with a high Ki-67 labeling index (6.7%).
Findings:
- The tumor infiltrated the superior sagittal sinus, contributing to the complex presentation.
- Tumor cells were found within the subdural hematoma, strongly suggesting tumoral hemorrhage as the cause.
- The high Ki-67 index indicates significant tumor cell proliferation.
Implications:
- This case highlights that even fibrous meningiomas can cause significant intracranial hemorrhage.
- Elevated cell proliferation may be a marker for increased risk of hemorrhage in meningiomas.
- Prompt surgical intervention is crucial for managing symptomatic meningiomas with hemorrhage.