Abstract
Abnormal cerebral vasculature can be a manifestation of a vascular malformation or a neoplastic process. We report the case of a patient with angiography-negative subarachnoid hemorrhage (SAH) who re-presented 3 years later with a large intraparenchymal hemorrhage. Although imaging following the intraparenchymal hemorrhage was suggestive of arteriovenous malformation, the patient was ultimately found to have an extensive glioblastoma associated with abnormal tumor vasculature. The case emphasizes the need for magnetic resonance imaging to investigate angiography-negative SAH in suspicious cases to rule out occult etiologies, such as neoplasm. We also discuss diagnostic pitfalls when brain tumors are associated with hemorrhage and abnormal vasculature.
Highlights
Subarachnoid hemorrhage (SAH) results from both traumatic and non-traumatic etiologies
We report the case of a patient with angiography-negative subarachnoid hemorrhage (SAH) who re-presented 3 years later with a large intraparenchymal hemorrhage
While vascular malformations such as arteriovenous malformations (AVM) and aneurysms account for the majority of non-traumatic SAH, no specific cause can be found in many cases
Summary
Reviewed by: Alexander Tsiskaridze, Tbilisi State University, Georgia Marc Malkoff, University of New Mexico, USA Muhammad S. Abnormal cerebral vasculature can be a manifestation of a vascular malformation or a neoplastic process. We report the case of a patient with angiography-negative subarachnoid hemorrhage (SAH) who re-presented 3 years later with a large intraparenchymal hemorrhage. Imaging following the intraparenchymal hemorrhage was suggestive of arteriovenous malformation, the patient was found to have an extensive glioblastoma associated with abnormal tumor vasculature. The case emphasizes the need for magnetic resonance imaging to investigate angiography-negative SAH in suspicious cases to rule out occult etiologies, such as neoplasm. We discuss diagnostic pitfalls when brain tumors are associated with hemorrhage and abnormal vasculature
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