Meningioma with purely intratumoral hemorrhage mimicked intracerebral hemorrhage: Case report and literature review

Abstract

Meningiomas are the most common non-glial intracranial tumor with an incidence of 2.3-5.5/100,000 people, accounting for 20-30% of all primary adult brain tumor diagnoses. Meningiomas associated with hemorrhage are rare; the reported incidence is 0.5-2.4%. We share a case experience of meningioma with purely intratumoral hemorrhage. The initial image study of the intratumoral hemorrhage mimicked intracerebral hemorrhage. A 63-year-old woman with initial presentation of headache, dizziness, nausea, and vomiting has brought to the emergent department. The brain computed tomography showed a 5.3 cm hyperdense lesion over the left occipitotemporal area. Under the impression of intracerebral hemorrhage with unknown etiology, the brain magnetic resonance imaging was done for tumor survey and showed lobulated enhanced mass over left T-O area. Tumor with bleeding with skull bone invasion was first considered. The surgical pathology revealed atypical meningioma with focal clear cell change (World Health Organization Grade II), which is separated with the brain by pia meter. Meningiomas associated with hemorrhage are rare; the reported incidence is 0.5-2.4%. The clinical features about increasing bleeding tendency: (i) age >70 years old or <30 years old; (ii) the location of meningiomas locate at intraventricle or convexity; (iii) histopathalogical type: Meningotheliomatous, malignant, fibrous, and angioblastic type. Most reported intracranial hemorrhages associated with meningiomas are found in the subarachnoid and subdural spaces. There are several hypotheses for the possible mechanism of tumoral bleeding. The tumoral bleeding in meningioma is a rare event. The incidence depended on the location and the histopathological finding. There might be other indicators but still need more research.