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Reier L, Mao C, Hough J, Pudewa F, Siddiqi I, Marino MA, Alastra A. Spontaneous Intracerebral Hemorrhage Secondary to a Parasagittal Meningioma: A Case Report and Review of the Literature. Cureus 2023; 15:e46863. [PMID: 37954803 PMCID: PMC10637778 DOI: 10.7759/cureus.46863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
Meningiomas are the most prevalent tumors within the central nervous system, with most exhibiting benign characteristics. While they are often discovered incidentally, their growth can lead to symptoms such as headaches, visual changes, dizziness, and seizures. Intratumoral hemorrhage (ITH) within meningiomas is a rare occurrence. This phenomenon carries a poor prognosis, as evidenced by significant rates of morbidity and mortality. This case report describes a unique case of a 52-year-old male who experienced a spontaneous right parietal lobe intracerebral hemorrhage adjacent to the superior sagittal sinus. Subsequent investigations revealed this to be an ITH due to an underlying WHO-grade I meningioma. This case emphasizes that while ITH in meningiomas is rare, prompt recognition and surgical intervention ensure optimal patient outcomes.
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Affiliation(s)
- Louis Reier
- Neurosurgery, Arrowhead Regional Medical Center, Colton, USA
| | - Christina Mao
- General Surgery, Valley Health System, Las Vegas, USA
- Neurology, St. George's University School of Medicine, Whittier, USA
| | - Jordan Hough
- Neurosurgery, Arrowhead Regional Medical Center, Colton, USA
- Neurosurgery, California University of Science and Medicine, Colton, USA
| | - Fiona Pudewa
- Neurosurgery, California University of Science and Medicine, Colton, USA
| | - Imran Siddiqi
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Maxwell A Marino
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Anthony Alastra
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
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Matias R, Arantes M, Azevedo J, Jacome M, Aguiar A. Meningioma Presenting With Intratumoral Hemorrhage on Active Surveillance. Cureus 2023; 15:e41787. [PMID: 37575809 PMCID: PMC10421599 DOI: 10.7759/cureus.41787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 08/15/2023] Open
Abstract
Meningiomas are relatively common primary adult brain tumors. They are slow-growing, highly vascular, and graded according to histology, phenotypic and genotypic features. We present a case of a 66-year-old male with a history of tongue squamous cell carcinoma, which presented multiple risk factors for cardiovascular and thromboembolic events. A brain lesion was initially detected on a computed tomography (CT) scan and later characterized by magnetic resonance imaging (MRI). The multidisciplinary team decided to maintain surveillance due to the lack of associated symptoms. Upon expansion in size and acute intralesional hemorrhage seen on follow-up imaging, the patient was submitted to surgical excision. The histopathological testing determined it to be an atypical meningioma. Two months later, the patient received stereotactic radiotherapy, and a post-surgical MRI showed no evidence of tumor recurrence. This case report describes a rare occurrence of intratumoral hemorrhage in a meningioma during surveillance, highlighting the importance of vigilant monitoring and consideration of potential risk factors for hemorrhagic events.
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Affiliation(s)
- Rafael Matias
- Radiation Oncology, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, PRT
| | - Mavilde Arantes
- Neuroradiology, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, PRT
| | - Júlia Azevedo
- Pathology, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, PRT
| | - Manuel Jacome
- Pathology, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, PRT
| | - Artur Aguiar
- Radiation Oncology, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, PRT
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Muacevic A, Adler JR, Picão Fernandes A, Pinto A, Meireles L. Let Us Not Forget About Bleeding: A Case Report and Brief Literature Review on Hemorrhagic Vestibular Schwannoma. Cureus 2022; 14:e32269. [PMID: 36620834 PMCID: PMC9815954 DOI: 10.7759/cureus.32269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Hemorrhagic vestibular schwannoma (HVS) consisting of acute intratumoral and subarachnoid hemorrhage is a rare phenomenon. We present the case of a 31-year-old woman who attended the Otorhinolaryngology department with right-sided intense tinnitus, dizziness, imbalance, and headache. Brain computed tomography revealed a spontaneous hyperdensity in the posterior fossa with marked deformation of the brainstem, middle cerebral peduncle, and cerebellum, with the near collapse of the fourth ventricle. Ophthalmology evaluation confirmed bilateral papilledema. Brain magnetic resonance imaging confirmed a voluminous 33 x 28 x 29 mm extra-axial lesion centered on the right pontine-cerebellar angle cistern, extending from the plane of the trigeminal nerve/tent of the cerebellum. The acoustic pore was enlarged. The patient underwent retrosigmoid craniotomy and microscopic tumor resection showing significant improvement in the follow-up. Pathological findings confirmed HVS. Delayed treatment of HVS can increase morbidity or even be fatal. The objective of this work is to describe and revise HVS, in order to bring awareness to this uncommon entity.
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Jenson M, Nguyen QH, Fiester P, Patel J, Rao D. Meningiomas Can Present as Intracranial Hemorrhage in Rare Cases: A Case Report of a Patient With a History of Minor Trauma and Massive Intracranial Hemorrhage. Cureus 2022; 14:e25823. [PMID: 35822144 PMCID: PMC9271313 DOI: 10.7759/cureus.25823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 11/23/2022] Open
Abstract
Meningiomas are relatively common intracranial tumors. While typically discovered incidentally or related to symptoms from regional mass effect, on rare occasions, they can present as acute intracranial hemorrhage. We report a case of a 62-year-old male who presented with significant acute intracranial hemorrhage with a history of minor trauma. Imaging workup demonstrated a hemorrhagic mass to be the likely cause of the hemorrhage. Upon resection of the mass, pathology demonstrated meningioma. It is important to thoroughly investigate intracranial hemorrhage, particularly when it appears out of proportion to any known causative event, in order to accurately diagnose, manage, and treat these patients.
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Avalos LN, Morshed RA, Goldschmidt E. Hemorrhagic vestibular schwannoma: a case example of vestibular apoplexy syndrome. Illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21722. [PMID: 36303506 PMCID: PMC9379692 DOI: 10.3171/case21722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/10/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Acute intratumoral hemorrhage within a vestibular schwannoma, or vestibular apoplexy, is a rare condition. Unlike the typical insidious vestibulopathy typically caused by vestibular schwannoma growth, patients with vestibular apoplexy have an acute and severe presentation with nausea and emesis in addition to severe vertigo and hearing loss. Here, the authors present an illustrative case demonstrating this rare clinical condition and an operative video detailing the surgical management. OBSERVATIONS A 76-year-old man presented to the emergency department with acute-onset dizziness, left-ear fullness, double vision, gait ataxia, emesis, and facial numbness. Imaging revealed a 2.8-cm hemorrhagic left cerebellopontine angle lesion extending into the left internal auditory canal, consistent with hemorrhagic vestibular schwannoma. The patient subsequently underwent a retrosigmoid craniotomy for resection of the hemorrhagic mass, and by 1 month after surgery, all his presenting symptoms had resolved, allowing his return to daily activities. LESSONS Vestibular schwannomas typically present with decreased hearing and chronic vestibulopathy. Acute presentation should raise the suspicion for an apoplectic event, and surgical debulking may lead to improvement in most vestibular symptoms.
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Affiliation(s)
- Lauro N. Avalos
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Ramin A. Morshed
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Ezequiel Goldschmidt
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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Abolfotoh M, Brzezicki G, Fiester P, Tavanaiepour D. A Rare Case of Life-Threatening Multicompartmental Spontaneous Intracranial Hemorrhage From a Grade 1 Convexity Meningioma. Cureus 2021; 13:e19178. [PMID: 34877188 PMCID: PMC8642124 DOI: 10.7759/cureus.19178] [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: 10/06/2021] [Accepted: 10/29/2021] [Indexed: 11/25/2022] Open
Abstract
Meningiomas are slowly growing benign tumors. The incidence of hemorrhage associated with intracranial meningiomas is in the 0.5%-2.4% range. However, intracranial meningiomas with hemorrhagic presentation are associated with higher rates of overall major morbidity (36%) and mortality (21.1%). We report a case of a convexity meningioma presenting with intraparenchymal hematoma and bilateral acute subdural hematomas (SDH) in a comatose patient (Glasgow Coma Scale (GCS) score: 7) who had a history of recurrent episodes of headaches over the past few months. Hemorrhagic presentation of a meningioma is a rare but potentially devastating event. Early recognition of the potential underlying meningioma as a cause of bleeding followed by rapid appropriate additional imaging is crucial to direct treatment plans to achieve the best outcome.
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Affiliation(s)
| | | | - Peter Fiester
- Neuroradiology, University of Florida Health, Jacksonville, USA
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Sumi K, Suma T, Yoshida R, Kajimoto R, Kobayashi M, Katsuhara T, Hirayama K, Tang X, Otani N, Yoshino A. Massive intracranial hemorrhage caused by intraventricular meningioma: case report. BMC Neurol 2021; 21:25. [PMID: 33451289 PMCID: PMC7811261 DOI: 10.1186/s12883-021-02056-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background Meningiomas are the most common benign intracranial tumors, and commonly comprise high-vascularizing but slow-growing tumors. On the other hand, meningiomas arising from the ventricular system are of rare occurrence, and spontaneous hemorrhage is an infrequent event. Case presentation We describe here the rare clinical manifestations of a 28-year-old female with acute intracranial hemorrhage located in the trigone of the lateral ventricle who was initially thought to have suffered an acute cerebrovascular accident, but was subsequently confirmed to have a benign intraventricular meningioma. To clarify the clinical features of such a rare course of meningioma, we also present a short literature review of acute intracranial hemorrhage caused by intraventricular meningioma. Conclusions Ventricular meningioma presenting with hemorrhage such as acute stroke is a rare event, but recognition of such a pathogenesis is important. Although further accumulation of clinical data is needed, we suggest that early surgery should be undertaken in patients with lateral ventricular meningioma, even if it is not so large or asymptomatic.
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Affiliation(s)
- Koichiro Sumi
- Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Takeshi Suma
- Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Reona Yoshida
- Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Ryuta Kajimoto
- Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Masato Kobayashi
- Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Takamichi Katsuhara
- Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Koki Hirayama
- Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Xiaoyan Tang
- Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
| | - Naoki Otani
- Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Atsuo Yoshino
- Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan.
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Crisman CM, Patel AR, Winston G, Brennan CW, Tabar V, Moss NS. Clinical Outcomes in Patients with Renal Cell Carcinoma Metastases to the Choroid Plexus. World Neurosurg 2020; 140:e7-e13. [PMID: 32251814 DOI: 10.1016/j.wneu.2020.03.125] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Intraventricular metastatic brain tumors account for a small, but challenging, fraction of metastatic brain tumors (0.9%-4.5%). Metastases from renal cell carcinoma (RCC) account for a large portion of these intraventricular tumors. Although patient outcomes have been assumed to be poor, these have not been reported in a modern series with a multimodality treatment paradigm of radiotherapy (RT), resection, and cerebrospinal fluid (CSF) diversion. We have presented the first case series of patients with intraventricular metastatic tumors from RCC. METHODS We performed a single-institution retrospective review of patients with intraventricular RCC metastases treated from January 2003 to January 2019. Volumetric analysis was used to delineate the tumor size and the Kaplan-Meier method to evaluate the survival data. RESULTS A total of 22 intraventricular RCC metastases were identified in 19 patients with 61.3 patient-years of follow-up. The median patient age was 64 years, and the median tumor volume was 2.2 cm3. Overall, 19 metastases had been treated initially with RT. Of these, 16 had received stereotactic body RT and 3 had received whole brain RT. Three tumors were surgically excised and had received adjuvant stereotactic body RT in the upfront setting. Although 5 patients had presented with obstructive hydrocephalus, none had required CSF diversion. After treatment, 5 metastases had progressed, resulting in 1- and 3-year progression-free survival rates of 81.6% and 68%, respectively. The median overall survival was 2.8 years, with 1- and 5-year overall survival rates of 76.7% and 28.3%, respectively. Leptomeningeal carcinomatosis was not observed. CONCLUSIONS Despite the relatively limited overall survival for this population with metastatic cancer, comparable to contemporary parenchymal brain metastasis cohorts, reasonable local central nervous system control was achieved in most patients using a paradigm of focal RT and resection, where indicated. Finally, CSF diversion was not required even in patients presenting with hydrocephalus.
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Affiliation(s)
- Celina M Crisman
- Department of Neurosurgery, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Ankur R Patel
- Department of Neurosurgery and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Cameron W Brennan
- Department of Neurosurgery and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Viviane Tabar
- Department of Neurosurgery and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nelson S Moss
- Department of Neurosurgery and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, New York, New York.
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Hu S, Zhang Y, Sun Y, Yu Y, Wang J, Dai H, Sun F, Hu C. Lung metastases from intracranial bleeding meningioma: A case report. Medicine (Baltimore) 2018; 97:e0457. [PMID: 29668616 PMCID: PMC5916700 DOI: 10.1097/md.0000000000010457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Meningioma is slow-growing benign neoplasm that derived from the meningothelial cells of the arachnoid mater, and it is the most common type of primary brain tumor. Although cases of extracranial metastatic meningioma have been reported previously, few cases have reported the concurrent occurrence of primary meningioma with intratumoral bleeding and lung metastases. Here we report a case of meningioma with concurrent intratumoral bleeding and lung metastases. PATIENT CONCERNS The patient was admitted to our hospital with sudden left limb paralysis combined with complaints of headache and dizziness. DIAGNOSES Histopathological results confirmed the lung metastases derived from intracranial bleeding meningioma. INTERVENTIONS The magnetic resonance imaging (MRI) of brain and computed tomography (CT) of brain and lung were performed. OUTCOMES CT and MRI of brain showed an intracranial mass associated with intratumoral hemorrhage. Then, multiple lung metastases were observed in the right lung via CT images. The intracranial mass was excised through craniotomy firstly, and a thoracoscopic biopsy was performed 1 month later. The patient was hospitalized again after 1 year because of suddenly epilepsy and received effective symptomatic treatment until symptoms were relieved. Then the patient is lost to follow-up. LESSONS When meningiomas occurred nearby venous sinuses with aggressive behavior, a careful whole-body examination is recommended in order to find distant metastasis as early as possible.
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Affiliation(s)
- Su Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, P.R. China
| | - Yaqi Zhang
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Yue Sun
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, P.R. China
| | - Yang Yu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, P.R. China
| | - Jia Wang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, P.R. China
| | - Hui Dai
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, P.R. China
| | - Feng Sun
- Medical Imageology Department, The First Clinical Medical School, Medical College of Soochow University, Jiangsu, P.R. China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, P.R. China
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