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LETTER TO EDITOR
Year : 2013  |  Volume : 61  |  Issue : 3  |  Page : 329-330

Hemorrhage in meningioma: An unwanted outcome of pregnancy


Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission14-Apr-2013
Date of Decision16-Apr-2013
Date of Acceptance30-May-2013
Date of Web Publication16-Jul-2013

Correspondence Address:
Vivek Gupta
Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.115098

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How to cite this article:
Kumar S, Gupta V, Khandelwal N. Hemorrhage in meningioma: An unwanted outcome of pregnancy. Neurol India 2013;61:329-30

How to cite this URL:
Kumar S, Gupta V, Khandelwal N. Hemorrhage in meningioma: An unwanted outcome of pregnancy. Neurol India [serial online] 2013 [cited 2019 Sep 20];61:329-30. Available from: http://www.neurologyindia.com/text.asp?2013/61/3/329/115098


Sir,

Meningiomas account for 15-20% of all intracranial tumors with a female preponderance. Hemorrhages in meningioma are rare (1.3-2.4%) and most cases usually have subdural hemorrhage. [1]

A 30-year-old multiparous woman presented with one episode of seizure followed by altered sensorium on first post-partum day. Computed tomography head showed a well-defined hyperdense extra-axial mass in right frontal region with areas of hemorrhages and mass effect with midline shift to left [Figure 1]a and b and hyperostosis of adjacent frontal bone [Figure 2]. The patient was operated on emergency basis due to significant mass effect. Histopathological examination of the mass suggested meningothelial meningioma.
Figure 1: Plain computed tomography scan of the brain showing extra‑axial hyperdense mass in right frontal region with midline shift to left (a with the white arrow) areas of hemorrhage (b with Hounsfield values)

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Figure 2: Computed tomography scan of the brain bone window reveals hyperostosis of the frontal bone (white arrow) adjacent to lesion

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Pregnancy augments the growth of meningioma. [2] This increase in growth of meningiomas during pregnancy results from increased fluid volume of the tumor cells leading to vascular engorgement. Meningioma growth during the pregnancy also related to the elevated levels of estrogen and progesterone as evidenced by the presence of receptors for these hormones in the tumoral cells. [3] These hemodynamic alterations increase the endothelial proliferation, vascular occlusion with distal necrosis resulting in rupture of friable vascular channels leading to hemorrhage. The main factors associated with an increased tendency for hemorrhage in meningioma are intraventricular and convexity location, convexity meningiomas generally presented with a subdural hematoma, in contrast our patient being in convexity presented with intratumoral hemorrhage. An increased bleeding pre-disposition was found for fibrous, malignant and angioblastic types of meningiomas. Our patient being meningothelial type of meningioma presenting with hemorrhage is a rare entity.

 
  References Top

1.Bosnjak R, Derham C, Popoviæ M, Ravnik J. Spontaneous intracranial meningioma bleeding: Clinicopathological features and outcome. J Neurosurg 2005;103:473-84.  Back to cited text no. 1
    
2.Wahab M, Al-Azzawi F. Meningioma and hormonal influences. Climacteric 2003;6:285-92.  Back to cited text no. 2
[PUBMED]    
3.Simon RH. Brain tumors in pregnancy. Semin Neurol 1988;8:214-21.  Back to cited text no. 3
[PUBMED]    


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