- Department of Life, Health and Environmental Sciences (MESVA), University of L’Aquila, L’Aquila, Italy
- Department of Neurosurgery, San Salvatore City Hospital, L’Aquila, Italy
De Paulis Danilo
Department of Life, Health and Environmental Sciences (MESVA), University of L’Aquila, L’Aquila, Italy
DOI:10.4103/2152-7806.143724Copyright: © 2014 Hambra DV. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Hambra DV, Danilo DP, Alessandro R, Sara M, Juan GR. Meningioma associated with acute subdural hematoma: A review of the literature. Surg Neurol Int 30-Oct-2014;5:
How to cite this URL: Hambra DV, Danilo DP, Alessandro R, Sara M, Juan GR. Meningioma associated with acute subdural hematoma: A review of the literature. Surg Neurol Int 30-Oct-2014;5:. Available from: http://sni.wpengine.com/surgicalint_articles/meningioma-associated-acute-subdural-hematoma-review-literature/
Background:Classically meningiomas present with a gradual onset of symptoms and their acute presentation with hemorrhagic events seems to be a rare event. A review of the literature shows only 18 cases of meningioma associated with acute subdural hematoma. The possible mechanisms of hemorrhage are not yet fully understood.
Case Description:We report a case of sphenoid wing meningioma associated with acute subdural hematoma, without history of trauma. The presence of meningioma was discovered during the surgery. The tumor and hematoma were removed without postoperative complications.
Conclusions:The authors have discussed the etiology of an acute subdural hemorrhage and reviewed the pertinent literature.
Keywords: Acute subdural hematoma, hemorrhage, meningioma
Meningioma usually manifests with a gradual onset of symptoms.[
A 59-year-old male on prophylactic antiplatelet therapy was admitted to our institute with sudden headache and dysphasia, accompanied by nausea and vomiting. The patient complained of the following influenza symptoms: Weakness, fever, runny nose for the last 7 days. There is no history of traumatic events. Laboratory tests showed coagulation indices within normal limits. Computed tomography scan (CT scan) of the head showed an acute subdural hematoma that extended from the left frontal lobe to the left temporal lobe [
A left pterional craniotomy was performed. A massive acute subdural hematoma was evacuated and an extra-axial lesion was identified on the left sphenoid wing with evidence of tumor bleeding. A Simpson grade I excision was performed. The histopathological diagnosis deposed for angiomatous and papillary meningioma with angio-invasiveness aspects of the dura [
The average age of patients (60 years) is slightly higher than the normal peak incidence of meningiomas, with a female prevalence (11:7), but the most frequent localization is the convexity.
There is insufficient evidence to show that hypertension and antiplatelet therapy are the factors responsible for bleeding, although hypertension and anticoagulation have been documented as precipitating factors of the hemorrhage in meningiomas [
Bleeding in a malignant tumor generally results from weakness of neoplastic vessel, infiltration of tumor cells into the vessel, and tendency of the mural endothelium to proliferate, leading to vessel destruction and necrosis.
However, the mechanism leading to hemorrhage associated with meningioma is apparently not the same and not fully understood.[
Some authors have emphasized a high risk of hemorrhage in angioblastic and malignant meningiomas, although transitional subtypes are the most common. In angioblastic meningiomas, it has been assumed that the thin-walled vessels are too fragile, causing easy bleeding. In malignant meningiomas, like other anaplastic tumors, direct invasion or endothelial proliferation by the tumor may obstruct the vascular channel, producing congestion and necrosis, resulting in hemorrhage, which can extend into subdural space.[
In syncytial meningiomas, the bleeding is probably related to the presence of intratumoral vasoactive substances released, such as histamine, which could induce vasodilatation and tumoral hemorrhage.[
The mechanical stretching and distortion of bridging veins by meningiomas may also be associated with hemorrhage.[
Some authors do not believe there is a relationship between histological subtype and high risk of hemorrhage, but everyone seems to agree that age and sex of the patient do not show significant relationship with the hemorrhagic event.[
The role of the location of the meningioma is controversial. According to Worm et al., the localization of the tumor in the cerebral convexity increases the risk of hemorrhage.[
In our case, the lesion invaded the dura and destroyed the bone. In our opinion, the bone changes are the origin of the hemorrhage in the case presented. Acute subdural hematomas caused by meningiomas have high mortality, and although meningiomas tend to evolve slowly, radical excision should be recommended.
Moreover, the presence of a meningioma should always be suspected in the presence of non-traumatic acute subdural hematoma.
1. Chonan M, Niizuma K, Koyama S, Kon H, Sannohe S, Kurotaki H. An operated case of a meningioma causing acute subdural hematoma. No Shinkei Geka. 2013. 41: 235-9
2. Chaskis C, Raftopoulos C, Noterman J, Flament-Durand J, Brotchi J. Meningioma Associated with subdural haematoma: Report of 2 cases and review of the literature. Clin Neurol Neurosurg. 1992. 94: 269-74
3. El-Banhawy A, Walter W. Meningioma with acute onset. Acta Neurochir (Wien). 1962. 10: 194-206
4. Goyal A, Singh AK, Kumar S, Gupta V, Singh D. Subdural hemorrhage associated with falcine meningioma. Neurol India. 2003. 51: 419-21
5. Kashimura H, Arai H, Ogasawara K, Beppu T, Kurose A, Ogawa A. Lipomatous meningioma with concomitant acute subdural hematoma--case report. Neurol Med Chir (Tokyo). 2008. 48: 466-9
6. Lakshmi Prasad G, Ramdurg SR, Suri A, Mahapatra AK. A rare association of meningioma with intratumoral bleed and acute subdural hematoma. Neurol India. 2010. 58: 977-8
7. Lefranc F, Nagy N, Dewitte O, Baleriaux D, Brotchi J. Intrcranial meningiomas revealed by non-traumatic subdural haematomas. A series of four cases. Acta Neurochr (Wien). 2001. 143: 977-83
8. Martinez-Lage JF, Poza M, Martinez M, Esteban JA, Antunez MC, Sola J. Meningiomas with haemorrhagic onset. Acta Neurochir (Wien). 1991. 110: 129-32
9. Mitsuhara T, Ikawa F, Ohbayashi N, Imada Y, Abiko M, Inagawa T. A case of petrotentorial meningioma presented as an acute subdural hemorrhage. No Shinkei Geka. 2006. 34: 827-32
10. Niiro M, Ishimaru K, Hirano H, Yunoue S, Kuratsu J. Clinico-pathological study of meningiomas with haemorrhagic onset. Acta Neurochir (Wien). 2003. 145: 767-72
11. Nikawa S, Kawaguchi M, Sugimoto S, Hattori T, Ohkuma A. Meningioma associated with subdural hematoma: Case report. Neurol Med Chir (Tokyo). 1990. 30: 169-72
12. Okuno S, Touho H, Ohnishi H, Karasawa J. Falx meningioma presenting as acute subdural hematoma: Case Report. Surg Neurol. 1999. 52: 180-4
13. Renowden SA, Hourihan MD. Case report: Acute subdural haematoma an unusual presentation of a meningioma. Clin Radiol. 1992. 45: 351-2
14. Russell NA, Al-Fayez N, Joaquin AJ. Acute subdural hematoma with intracranial meningioma. Ann Saudi Med. 1993. 13: 369-71
15. Sato K, Sugawara T, Fujiwara S, Mizoi K, Yoshimoto T. A case of small meningioma with acute subdural hematoma. No Shinkei Geka. 1989. 17: 687-90
16. Shimizu J, Tazawa T, Park-Matsumoto YC, Katano T, Akiba Y, Kuroiwa T. Meningioma associated with acute subdural hematoma: A case report. No Shinkei Geka. 1998. 26: 743-7
17. Spektor S, Ashkenazi E, Israel Z. Intracranial haemorrhage from a meningioma in a patient receiving aspirin prophylaxis: A case report. Acta Neurochir (Wien). 1995. 134: 51-3
18. Sunada I, Nakabayashi H, Matsusaka Y, Yamamoto S. Meningioma associated with acute subdural hematoma-case report. Radiat Med. 1998. 16: 483-6
19. Tokunaga T, Kuboyama M, Kojo N, Matsuo H, Shigemori M, Kuramoto S. A case of acute subdural hematoma associated with convexity meningioma. No Shinkei Geka. 1988. 16: 1389-93
20. Ueno M, Nakai E, Naka Y, Kido T, Itakura T, Komai N. Acute subdural hematoma associated with vacuolated meningioma. Case Report. Neurol Med Chir (Tokyo). 1993. 33: 36-9
21. Wakai S, Yamakawa K, Manaka S, Takakura K. Spontaneus intracranial hemorrhage caused by brain tumor: Its incidence and clinical significance. Neurosurgery. 1987. 10: 437-44
22. Worm PV, Ferreira MP, Ferreira NP, Cechetti F. Subdural haematoma in a patient with meningioma. Arq Neuropsiquiatr. 2009. 67: 308-10