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Tanaka T, Kyaw MP, Anai S, Takase Y, Takase Y, Abe T, Matsuno A. Fatal convexity and interhemispheric acute subdural hematoma from a falx meningioma: A case report. Surg Neurol Int 2024; 15:115. [PMID: 38742007 PMCID: PMC11090548 DOI: 10.25259/sni_54_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/22/2024] [Indexed: 05/16/2024] Open
Abstract
Background Hemorrhagic meningiomas are rare. We report a rare case of nontraumatic convexity and interhemispheric acute subdural hematoma (ASDH) caused by a falx meningioma. Case Description An 84-year-old woman with a history of atrial fibrillation and hypertension who was taking warfarin presented to our emergency department with a sudden disorder of consciousness. The patient had no traumatic events associated with her symptoms. Computed tomography (CT) revealed right convexity and interhemispheric ASDH, mass lesions in the left frontal lobes, and brain herniation. Contrast-enhanced CT revealed vascular structures within the mass lesion. CT angiography (CTA) revealed no aneurysm or arteriovenous malformation, and the venous phase revealed occlusion in the anterior portion of the superior sagittal sinus. The patient had her right convexity and interhemispheric ASDH removed endoscopically. A mass lesion located on the falx, which was easily bleeding, soft, and suctionable, was immediately detected. Histopathological examination revealed fibrous meningioma, a benign meningioma of the World Health Organization grade 1. Despite undergoing aggressive treatment, the patient's general condition deteriorated. Conclusion Hemorrhagic meningiomas can easily be missed with plain CT, and the enhancement effect of CTA and tumor shadow on digital subtraction angiography may not be observed during the acute phase. Surgery for nontraumatic ASDH should be performed considering the possibility that a meningioma causes it.
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Affiliation(s)
- Tatsuya Tanaka
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita City, Japan
| | - May Pyae Kyaw
- Department of Neurosurgery Kouhoukai Takagi Hospital, Okawa, Japan
| | - Satoshi Anai
- Department of Neurosurgery Kouhoukai Takagi Hospital, Okawa, Japan
| | - Yukinori Takase
- Department of Neurosurgery Kouhoukai Takagi Hospital, Okawa, Japan
| | - Yukari Takase
- Department of Pathology, Kouhoukai Takagi Hospital, Okawa, Japan
| | - Tatsuya Abe
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Akira Matsuno
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita City, Japan
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Leclerc A, Gohel H, Malczuk J, Anzalone L, Emery E, Gaberel T. Systematic Review of Meningiomas Revealed by Spontaneous Intracranial Hemorrhage: Clinicopathological Features, Outcomes, and Rebleeding Rate. World Neurosurg 2023; 172:e625-e639. [PMID: 36738963 DOI: 10.1016/j.wneu.2023.01.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Meningiomas are rarely revealed by an intracranial hemorrhage (ICH). Rebleeding occurrence rate and time of onset are unknown. Here, we performed a systematic review of the literature of meningiomas revealed by ICH. METHODS We retrospectively collected all meningiomas revealed by spontaneous ICH published between January 1980 and December 2021. We reported clinicopathological features of meningiomas revealed by ICH. We also estimated rebleeding rate and time to onset. RESULTS Ninety-two studies met all inclusion criteria, led to a total of 120 cases. The mean age was 56.3 years, with 66 (55%) female. Seventy-nine (66%) cases were conscious before surgery, 20 (17%) were in coma, and 17 (14%) were unconscious after deterioration. The most frequent bleeding type was subdural hemorrhage (N = 49, 41%) followed by intraparenchymal hemorrhage (IPH) (N = 44, 37%), subarachnoid hemorrhage (SAH) (N = 22, 18%), and intraventricular hemorrhage (IVH) (N = 5, 4%). IPH and hindbrain/ventricular locations are associated with poor outcomes (P = 0.031 and < 0.001, respectively). Among the 19 patients who did not undergo surgical resection of the meningioma, 14 (74%) experienced rebleeding with a median occurrence of 120 days (interquartile, [90; -]). Rebleeding occurs earlier if the type of bleeding is SAH or IVH and for hindbrain location (both P < 0.01). CONCLUSIONS ICH is a rare presentation of meningiomas. Hindbrain and ventricular tumor location and IPH are associated with poor outcomes. Rebleeding rate is high and premature. It occurs earlier if the first bleeding was SAH or IVH and for hindbrain location.
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Affiliation(s)
- Arthur Leclerc
- Department of Neurosurgery, CHU de Caen-Normandie, Caen, France; Normandie Université, UNICAEN, Caen, France.
| | | | - Joséphine Malczuk
- Department of Neurosurgery, CHU de Caen-Normandie, Caen, France; Normandie Université, UNICAEN, Caen, France
| | - Louis Anzalone
- Department of Neurosurgery, CHU de Caen-Normandie, Caen, France; Normandie Université, UNICAEN, Caen, France
| | - Evelyne Emery
- Department of Neurosurgery, CHU de Caen-Normandie, Caen, France; Normandie Université, UNICAEN, Caen, France; Normandie Université, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, Caen, France
| | - Thomas Gaberel
- Department of Neurosurgery, CHU de Caen-Normandie, Caen, France; Normandie Université, UNICAEN, Caen, France; Normandie Université, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, Caen, France
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Cerase A, Tampieri D, Miracco C, Grazzini I. Diagnostic neuroradiology of intracranial meningiomas presenting with hemorrhagic onset: a double center 14-year experience. Emerg Radiol 2023; 30:175-185. [PMID: 36707465 DOI: 10.1007/s10140-023-02115-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/23/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE This study aims to increase awareness of the hemorrhagic presentation of intracranial meningiomas in the emergency department and present clues for neuroradiological diagnosis, which is crucial for pertinent management. We described the prevalence of hemorrhage in a large population of meningioma patients, with emphasis on clinical presentation, computed tomography (CT), magnetic resonance (MR), and digital subtraction angiography (DSA) findings. METHODS This retrospective analysis has been performed at two reference institutions between January 2002 and December 2015, and includes 1304 patients with histologically proven newly diagnosed intracranial meningioma. Clinical features and neuroradiological findings of intracranial meningiomas presenting with hemorrhage have been reviewed. RESULTS Twenty-four patients (1.8%, 16 females, 8 males, age range: 29-88 years) were found to have spontaneous hemorrhagic onset of the newly diagnosed meningioma. A sudden onset occurred in 23/24 patients. Sixteen patients showed isolated intralesional hemorrhage, four had subdural hematomas, and the remaining four presented combined intralesional and subarachnoid (n = 2) or intraventricular (n = 2) hemorrhages. In 13 patients, CT showed both the hemorrhage and the meningioma. In the other 11 patients, diagnosis was achieved by emergency or early surgery (n = 5), MRI (n = 5), and DSA (n = 1). CONCLUSIONS The presence of an underlying meningioma has to be considered in the differential diagnosis of spontaneous intracranial hemorrhage, although this is a rare event. CT, MRI, and occasionally DSA were useful to obtain the diagnosis; however, in up to a fifth of patients, this was achieved at surgery.
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Affiliation(s)
- Alfonso Cerase
- Unit of Neuroimaging, Diagnostic and Functional Neuroradiology, Clinical Department of Neurological and Motor Sciences, Azienda Ospedaliero-Universitaria Senese, Santa Maria Alle Scotte National Health System and University Hospital, Tuscany, Siena, Italy
| | - Donatella Tampieri
- Department of Radiology, Diagnostic and Interventional Neuroradiology, Kingston Health Science Centre, Queen's University, Kingston, ON, Canada
| | - Clelia Miracco
- Unit of Pathology, Clinical Department of Oncology, Azienda Ospedaliero-Universitaria Senese and Department of Medicine, Surgery, and Neurosciences, University of Siena, Santa Maria Alle Scotte National Health System and University Hospital, Tuscany, Siena, Italy
| | - Irene Grazzini
- Department of Diagnostic Imaging, Section of Neuroradiology, San Donato National Health System Hospital, Pietro Nenni Street, 52100, Arezzo, Tuscany, Italy.
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Halalmeh DR, Alrashdan M, Kharouf M, Sbeih I, Molnar PT, Moisi MD. Brain Meningiomas Manifesting as Intracranial Hemorrhage: Comprehensive Systematic Review and Report of the First Case of Hemorrhagic Meningiomatosis. World Neurosurg 2023; 169:73-86.e6. [PMID: 36332779 DOI: 10.1016/j.wneu.2022.10.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To characterize the salient features of hemorrhagic manifestation of meningiomas and to report on the first case of hemorrhagic meningiomatosis. METHODS A comprehensive systematic review of the English-language literature was performed using MEDLINE, PubMed, and Google Scholar databases to identify case reports and series of brain meningiomas manifesting as intracranial hemorrhage. RESULTS A total of 65 patients were evaluated. Most patients were female (64.6%). The average age at presentation was 58.1 ± 14.3 years. The most common presenting symptom was focal neurologic deficits (n = 47; 71.2%). Identification of tumor was missed/not possible in 24.6% of patients. The most common reported comorbidity was hypertension. Most tumors were located in convexity (n = 36; 55.3%). Subdural hematoma (± other hemorrhages) was the most common type of intracranial hemorrhage (n = 46; 70.7%). Computed tomography hyperintensity (25.7%) and magnetic resonance imaging T2 hypointensity (22%) were the most prevalent radiologic findings. The predominant histopathology subtype was meningothelial (syncytial) (n = 24; 36.4%). The estimated mortality was 13.8%. Among those who survived, 39.9% had residual deficits at a median follow-up of 8.1 ± 5.8 months. CONCLUSIONS Intracranial hemorrhage induced by meningiomas is associated with significant mortality and morbidity. Identifying unexpected meningioma in the setting of intracranial bleed can help optimize preoperative planning (e.g., surgical approach) and facilitate total resection of the underlying tumor. Therefore, clinicians should have a high index of suspicion with a low threshold for investigation of meningiomas in the setting of intracranial hemorrhage.
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Affiliation(s)
- Dia R Halalmeh
- Department of Neurosurgery, Hurley Medical Center, Flint, Michigan, USA.
| | | | | | | | - Petrica T Molnar
- Department of Neurosurgery, Hurley Medical Center, Flint, Michigan, USA
| | - Marc D Moisi
- Department of Neurosurgery, Hurley Medical Center, Flint, Michigan, USA
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Huang R, Su S, Yang Z, Wang H, Hong L, Chen L, Wu X, Zheng Y, Zhuang R, Liu Y. Neuroradiologic Findings and Clinical Features of Meningiomas With Spontaneous Hemorrhagic Onset: A Single-center 10-year Experience. World Neurosurg 2022; 162:e605-e615. [PMID: 35338017 DOI: 10.1016/j.wneu.2022.03.080] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/17/2022] [Accepted: 03/17/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study aimed to elucidate the clinicoradiologic features of spontaneous hemorrhagic meningiomas (HMs) and examine risk factors associated with meningioma hemorrhage. METHODS We retrospectively reviewed 651 consecutive meningioma patients who underwent surgical resection in our hospital between January 2011 and January 2021. After exclusions, 169 patients were included for analysis. Patients were grouped according to presence of hemorrhage in the meningioma: the HM group (n = 19) and non-HM group (n = 150). Clinicoradiologic patient data were examined and compared using univariate and multivariate analysis. RESULTS HMs accounted for 2.9% of the entire series of meningiomas. HMs were mainly located at the convexity (63.2%). Mean diameter of HMs was 4.8 cm. On computed tomography, most HMs appeared as mixed isodensity and hyperdensity (84.2%). On magnetic resonance imaging, most appeared as mixed isointensity and hyperintensity on T1-weighted imaging and mixed hypointesity and hyperintensity on T2-weighted imaging (52.6%). Seventeen tumors exhibited heterogeneous enhancement, a dural tail, and peritumoral brain edema. Thirteen showed intratumoral cystic change. The misdiagnosis rate was significantly higher in HMs than non-HMs (31.6% vs. 7.3%; P = 0.005). Intratumoral cystic change was the only independent predictor of meningioma hemorrhage in multivariate analysis (odds ratio 4.116; 95% confidence interval 1.138-14.894; P = 0.031). CONCLUSIONS Mixed isodensity/intensity and hyperdensity/intensity on computed tomography/magnetic resonance imaging in conjunction with heterogenous enhancement, a dural tail, and varying degrees of peritumoral brain edema suggest a high possibility of HM. Presence of intratumoral cystic change was an independent risk factor associated with meningioma hemorrhage.
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Affiliation(s)
- Ruibin Huang
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R.China
| | - Shuyan Su
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R.China
| | - Zhiqi Yang
- Department of Radiology, Meizhou People's Hospital, Meizhou, Guangdong, P.R.China
| | - Huanpeng Wang
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R.China
| | - Liangli Hong
- Department of Pathology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R.China
| | - Liujiang Chen
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R.China
| | - Xiaojia Wu
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R.China
| | - Yungui Zheng
- Department of Neurosurgery, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R.China
| | - Ruyao Zhuang
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R.China
| | - Yuan Liu
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R.China
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Huang RB, Chen LJ, Su SY, Wu XJ, Zheng YG, Wang HP, Zhuang RY, Liu Y. Misdiagnosis and Delay of Diagnosis in Hemorrhagic Meningioma: A Case Series and Review of the Literature. World Neurosurg 2021; 155:e836-e846. [PMID: 34520866 DOI: 10.1016/j.wneu.2021.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/04/2021] [Accepted: 09/06/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the clinicoradiologic characteristics of hemorrhagic meningiomas (HMs) that are missed or misdiagnosed on radiologic imaging studies. METHODS Clinical and radiologic data from 6 patients with HM who were initially misdiagnosed were collected and recorded respectively. In addition, we performed a literature review for misdiagnosed HM and summarized the results. RESULTS Five of the 6 patients with misdiagnosed HM were female, and 1 was male. Both computed tomography (CT) and magnetic resonance imaging were performed in 4 patients, and CT alone was performed in 2. On CT, the HM was heterogeneously hyperdense in 5 patients and isodense in 1 patient. In all 4 patients who underwent magnetic resonance imaging, the HM was mixed iso- and hypointense on T1-weighted imaging and heterogeneously hyperintense on T2-weighted imaging. Marked heterogeneous contrast enhancement was observed in 2 patients, strong rim enhancement in 1, and peripheral enhancement in 1. The dural tail sign was seen in only 1 patient. The initial radiologic misdiagnoses were subdural hematoma (n = 1), malignant glioma (n = 1), ruptured arterial aneurysm (n = 1), metastasis (n = 2), and uncertain (n = 1). In the literature review, 22 cases of HM diagnostic error were collected. The main misdiagnoses were subdural hematoma (27.3%), traumatic hematoma (13.6%), vascular anomaly (13.6%), malignant glioma (4.5%), and metastasis (4.5%). CONCLUSIONS Our study showed that in patients with HM with inadequate imaging evaluation, a small tumor associated with massive hematoma and atypical imaging features was more likely to be misdiagnosed.
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Affiliation(s)
- Rui-Bin Huang
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P. R. China
| | - Liu-Jiang Chen
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P. R. China
| | - Shu-Yan Su
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P. R. China
| | - Xiao-Jia Wu
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P. R. China
| | - Yun-Gui Zheng
- Department of Neurosurgery, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P. R. China
| | - Huan-Peng Wang
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P. R. China
| | - Ru-Yao Zhuang
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P. R. China.
| | - Yuan Liu
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P. R. China
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Han S, Yang Y, Yang Z, Liu N, Qi X, Yan C, Yu C. Continuous progression of hemorrhage of sphenoid ridge meningioma causing cerebral hernia: A case report and literature review. Oncol Lett 2020; 20:785-793. [PMID: 32566005 PMCID: PMC7285884 DOI: 10.3892/ol.2020.11590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 03/05/2020] [Indexed: 01/14/2023] Open
Abstract
The aim of the present study was to explore the clinical characteristics of repeated hemorrhages of meningioma and analyze the causes of hemorrhage. Meningiomas are mostly benign tumors that rarely manifest hemorrhagic strokes. In the present study, a case of sphenoid ridge meningioma with repeated hemorrhages is reported. Internal hemorrhage was first observed, which, on further aggravation, formed a hematoma in the brain parenchyma and finally led to the development of a hernia. No neurological deficit was present after surgery and rehabilitation. A postoperative pathological examination showed increased levels of Ki-67, abnormal blood vessels in the tumors and the presence of progesterone, which indicate possible causes of the hemorrhage. A review of associated previous studies revealed that hemorrhages originate mainly from inside the meningioma. Two cases of meningiomas with repeated hemorrhages have been reported; one in the foramen magnum region and the other in the pineal gland area. The foramen magnum tumor had an interval of 1.33 months between two hemorrhagic episodes. Collecting relevant data from the latter case was not possible. In the present case report, the interval between two bleeding episodes was 3 days. The literature review also revealed that the average age of onset of meningioma is relatively young at only 28.00±6.24 years. In conclusion, repeated hemorrhages in meningiomas are extremely rare and the causes have not yet been identified. Increased Ki-67 and abnormally proliferating blood vessels may be potential causes of hemorrhage. Early diagnosis and rapid surgical intervention are essential to prevent further episodes of bleeding, which may otherwise have fatal consequences for the patients.
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Affiliation(s)
- Song Han
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, P.R. China
| | - Yakun Yang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, P.R. China
| | - Zuocheng Yang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, P.R. China
| | - Ning Liu
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, P.R. China
| | - Xueling Qi
- Department of Pathology, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, P.R. China
| | - Changxiang Yan
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, P.R. China
| | - Chunjiang Yu
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, P.R. China
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