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The authors report a case of acoustic neurinoma presenting as intratumoral bleeding. This is the tenth reported occurrence. The literature is reviewed. All cases that have been reported have appeared with sudden onset of headache, vomiting, and decreased levels of consciousness. Aneurysm rupture, an arteriovenous malformation, or other vascular anomalies are suspected first. Preexisting unilateral hearing impairment is a valuable clue to differential diagnosis. Contrast-enhanced computed tomographic scans and cerebral angiograms are important tools for correct diagnosis. The tumor size (greater than 2 cm) and the thin, dilated vessels within the tumor are considered as pathogenetic factors for bleeding. When neurological status is not stable, placement of a ventriculoperitoneal shunt followed by urgent extirpation of the tumor is indicated.

A group of 57-head injured patients showing computerized tomographic (CT) findings compatible with "diffuse brain injury" or of the so called "diffuse axonal injury" is analyzed. Thirty-four patients showed intraparenchymal hemorrhage in the CT scan study, 8 intraventricular hemorrhage and 15 patients had both intraparenchymal and intraventricular hemorrhage. Forty percent (23/57) of those with these findings had associated intracranial focal lesions. The deep nuclei are the most common location of intraparenchymal hemorrhage. Signs of brain stem hemorrhage were seen in 9 patients. Forty-nine percent of patients in this series had a good outcome. Old age (>60), abnormal motor response, abnormal eye signs, associated with focal lesions, and evidence of brain stem hemorrhage are reliable prognostic parameters for a grave outcome. RESUME: Hemorragie intraparenchymateuse et intraventriculaire sans effet de masse dans le coma traumatique Nous analysons les cas de 57 patients ayant subi un traumatisme cranien et qui presentaient, a la tomographic assistee par ordinateur (CT), des modifications compatibles avec "des lesions cerebrales diffuses" ou "des lesions axonales diffuses". Trente-quatre patients presentaient une hemorragie intraparenchymateuse a l'etude par CT scan, soit 8 patients avec hemorragie intraventriculaire et 15 avec hemorragie intraparenchymateuse et intraventriculaire. 40% (23/57) de ces patients avaient des lesions focales intracraniennes associees. Les noyaux de la base sont le site le plus frequent d'hemorragie intraparenchymateuse. Des signes d'hemorragie du tronc cerebral ont ete observes chez 9 patients. 49% des patients dans cette etude ont eu une issue favorable. Un age avance (>60 ans), une reponse motrice anormale, des signes oculaires anormaux, des lesions focales associees et des manifestations d'une hemorragie du tronc cerebral sont des parametres fiables indiquant un pronostic sombre.