Intraarterial schwannoma in horizontal segment of middle cerebral artery causing subarachnoid hemorrhage

Abstract

A spontaneous subarachnoid hemorrhage (SAH) from the middle cerebral artery is most commonly caused by the rupture of saccular aneurysms and rarely by fusiform aneurysms or arterial dissections/dissecting aneurysms. To the authors' knowledge, this is the first report of an intraarterial neoplasm causing an SAH. A 44-year-old woman presented with an SAH in the basal cisterns. Subsequent internal carotid artery angiography demonstrated a small bulge on the superior wall of the horizontal (M1) segment of the middle cerebral artery. However, a pterional craniotomy revealed a well-circumscribed solitary tumor with a diameter of 15 mm involving the superior wall of the M1 segment as the cause of the SAH. Pathological examination demonstrated typical findings of a schwannoma, elongated cells with tapered, spindle-shaped nuclei and indistinct cell borders, and diffuse immunoreactivity for the S100 protein.