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 »  Abstract
 »  Introduction
 »  Case Report
 »  Discussion
 »  Acknowledgements
 »  References

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Year : 2003  |  Volume : 51  |  Issue : 3  |  Page : 419-421

Subdural hemorrhage associated with falcine meningioma

Department of Neurosurgery, G. B. Pant Hospital, J. L. Marg, New Delhi - 110002

Correspondence Address:
60, Anandlok, New Delhi - 110049
[email protected]

  »  Abstract

A case of falcine meningioma associated with acute subdural hemorrhage is reported. The possible mechanisms of hemorrhage in the case are discussed. We believe that an early recognition and surgery can prevent neurological deterioration.

How to cite this article:
Goyal A, Singh A, Kumar S, Gupta V, Singh D. Subdural hemorrhage associated with falcine meningioma . Neurol India 2003;51:419-21

How to cite this URL:
Goyal A, Singh A, Kumar S, Gupta V, Singh D. Subdural hemorrhage associated with falcine meningioma . Neurol India [serial online] 2003 [cited 2021 Aug 4];51:419-21. Available from:

   »   Introduction Top

Intracranial tumors presenting with hemorrhage constitute 3.9% of all tumors, more in malignant pathology such as metastatic tumors or gliomas.[1] Benign intracranial tumors like meningiomas rarely present with hemorrhage, and the reported incidence is about 1.3% of all meningiomas.[2] There are several hypotheses explaining the probable cause of the hemorrhage.[3],[4],[5],[6] We present a case of falcine meningioma with convexity acute subdural hemorrhage, and discuss the management strategy.

   »   Case Report Top

A 66-year-old male presented with complaints of generalized headache for the last 2 years. But for the last 4 days the intensity of the headache increased markedly and was associated with vomiting. Neurological examination revealed no focal abnormality, except for bilateral papillodema. Biochemical and hematological investigations were within the normal range. Computerized tomography (CT) scan showed a falcine meningioma and an acute subdural hemorrhage on the same side [Figure - 1]. During surgery, a large partially liquefied subdural clot was evacuated. In addition, the vascular falcine meningioma was totally resected. The patient recovered well after surgery and was relieved of his symptoms. Histopathology confirmed that the tumor was a transitional meningioma.

   »   Discussion Top

Spontaneous hemorrhage associated with meningioma is uncommon. It is unrelated to the sex and age of the patient, presence of systemic hypertension or the tumor location.[5],[6],[7],[8],9] Intracerebral, subdural and subarachnoid hemorrhage have all been reported in conjunction with intracranial meningiomas.[5],[6] In a review of 45 cases on the subject, Kohli et al[5] identified the hemorrhage to be outside the tumor confines in 35 cases and in 16 of these cases the hemorrhage was intracerebral in location. The most common type of bleeding was subarachnoid hemorrhage followed by intracerebral hemorrhage and intratumoral hemorrhage. Helle and Conley[4] reported a higher risk of hemorrhage in angioblastic and malignant meningioma.
Several hypotheses concerning spontaneous hemorrhage in meningiomas have been proposed. The most common hypothesis is the rupture of the abnormal vascular networks of tumor. This is based on histological findings such as weak thin-walled vessels or direct peritumoral vascular erosion by the tumor.[4],[5],[9],[10],[11],[12] However, only a few of the tumors show abnormal vasculature bleeding. Rapid growth of the tumor or venous thrombosis leading to tumor necrosis has been implicated. Gruskiewicz et al mentioned that necrosis of the tumor can cause direct breakdown of the tumor vessels and subsequent hemorrhage.[11] Another hypothesis proposed by Askenasy et al is that enlarged, tortuous feeding arteries are less resistant to blood pressure changes and susceptible to rupture.[13],[14] Rupture of the bridging veins secondary to their stretch is also a probable cause of hemorrhage.[8] Kim et al[15] identified infarction of the meningioma in cases with hemorrhage.[4],[11],[16] They speculated that as the tumor infarction progresses, rupture of the peritumoral vessels occurs eventually. Events like seizures or a rapid change in the blood pressure may also act as contributory factors. Coagulopathy, seizures, trauma and malignant transformation of the meningioma have also been considered as possible causes of hemorrhage in a meningioma.[7],[13]

   »   Acknowledgements Top

Dr. Goyal is working as a Senior Research Associate under CSIR, Delhi and is posted at the G.B.Pant Hospital, Delhi. We acknowledge their help and support.

  »   References Top

1.Saleman M. Intracranial hemorrhage caused by brain tumor. In: Kaufman HH, editor. Intracerebral hematomas. New York: Raven Press; 1992. pp. 95-106.  Back to cited text no. 1    
2.Modesti LM, Binet EF, Collins GH. Meningiomas causing spontaneous intracranial hematomas. J Neurosurg 1976;45:437-41.  Back to cited text no. 2  [PUBMED]  
3.Everett BA, Kusske JA, Pribram HW. Anticoagulants and intracerebral hemorrhage from an unsuspected meningioma. Surg Neurol 1979;11:233-5.  Back to cited text no. 3  [PUBMED]  
4.Helle TL, Conely FK. Hemorrhage associated with meningioma; a case report and review of the literature. J Neurol Neurosurg Psychiatry 1980;43:  Back to cited text no. 4    
5.725-9.  Back to cited text no. 5    
6.Kohli CM, Crouch RL. Meningioma with intracerebral hematoma. Neurosurgery 1984;15:237-40.  Back to cited text no. 6  [PUBMED]  
7.Shojima K, Hayashi T, Higashihara H, et al. Cystic meningioma associated with intratumor and subarachnoid hemorrhage during Embolization - a case report. No Shinkei Geka 1986;14:919-24.  Back to cited text no. 7  [PUBMED]  
8.Lazaro RP, Meser HD, Brinker RA. Intracerebral hemorrhage associated with meningiomas. Neurosurgery 1981;8:96-101.  Back to cited text no. 8    
9.Martinez-Lage JF, Poza M, Martinez M, et al. Meningioma with hemorrhagic onset. Acta Neurochir (Wien) 1991;110:129-32.  Back to cited text no. 9  [PUBMED]  
10.Pluchino F, Lodrini S, Savoiardo M. Subarachnoid hemorrhage and meningiomas: report of two cases. Acta Neurochir (Wien) 1983;68:45-53.  Back to cited text no. 10  [PUBMED]  
11.Chaskis C, Raftopoulos C, Noterman J, et al. Meningioma associated with subdural hematoma: Report of two cases and review of the literature. Clin Neurol Neurosurg 1992;94:269-74.  Back to cited text no. 11  [PUBMED]  
12.Gruszkiewicz J. Doron Y, Gellei B, et al. Massive intracerebral bleeding due to supratentorial meningioma. Neurochirurgia (Stuttg) 1969;12:107-11.  Back to cited text no. 12    
13.Nakao S, Sato S, Ban S, et al. Massive intracerebral hemorrhage cause by angioblastic meningioma. Surg Neurol 1977;7:245-8.  Back to cited text no. 13  [PUBMED]  
14.Bloomgarden GM, Byrne TN, Spencer DD, et al. Meningioma associated with aneurysm and subarachnoid hemorrhage: Case report and review of the literature. Neurosurgery 1987;20:24-6.  Back to cited text no. 14  [PUBMED]  
15.Askenasy HM, Behmoaram AD. Subarachnoid hemorrhage in meningiomas of the lateral ventricle. Neurology 1960;10:484-9.  Back to cited text no. 15  [PUBMED]  
16.Kim DG, Park CK, Pack SH, et al. Meningiomas manifesting intracerebral hemorrhage: A possible mechanism of hemorrhage. Acta Neurochir (Wien) 2000;142:165-8.  Back to cited text no. 16    
17.Onesti ST, Zahos PA. Ashkenazi E. Spontaneous hemorrhage into convexity meningiomas. Acta Neurochir (Wien) 1996;138:1250-1.   Back to cited text no. 17    


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