Subdural haematoma in a patient with meningioma

Abstract

Non-traumatic subdural haematomas are very rare especially those associated with intracranial meningiomas 1 . Intracranial tumors hemorrhage occurs in 39% of all cases. They are a malignant pathology such as metastatic tumors or gliomas. They usually present with seizures hemiparesis visual field loss aphasia or other focal sumptoms.We report a case of meningioma of the skull base associated with subdural haematoma after a Valsava maneuver. CaSeA 64-year old male patient, smoker, had a loss of consciousness with mild headache during a spirometric exam. He was medicated with analgesics and remained with headache for 12 hours and was discharged from hospital. He persisted with chronic headache and developed a gradual confusional state and left hemiparesia. After the initial episode, five days after the spirometric test, he returned to the hospital for a computed tomography (CT) of the head (Figs 1 and 2). The CT showed a right subdural haematoma with a fresh clot in the anterior skull base with bone thickness of the anterior fossa besides meningioma of the falx with adjacent edema.The patient had no prior history of trauma or alcoholism. He was using (AAS) 200 mg/day. Coagulation tests were normal.A right frontal osteoplastic craniotomy was performed draining the haematoma, and during the same surgical procedure the tumor was removed using microscopy.A dark, thick, red blood clot was drained. During the surgical drainage of the subdural haematoma two findings were observed by the surgeon: 1) the homolateral side of the subdural haematoma presented with greater vascular density. 2) the clot surface on this side showed a variable aspect, suggesting ac-

Meningioma associated with acute subdural hematoma: A review of the literature

“…Only 18 cases of meningioma with acute subdural hematoma have been reported. [ 1 4 5 6 7 9 11 12 13 14 15 16 17 18 19 20 22 ]…”

Recurrent acute subdural bleeding as a rare complication of a hemorrhagic non malignant meningioma.

“…Kashimura et al (10) adhered to this hypothesis, but for Worm et al (11) histological grading of the tumors failed to reveal significant relationship with hemorrhagic events.…”

“…Several hypotheses have been proposed to explain spontaneous hemorrhage associated with intracranial meningioma (10,11), e.g. rupture of abnormal tumor vessels, vaso-active substances released by meningiomas, venous thrombosis leading to tumor necrosis or rapid tumor growth leading to stretching of subdural bringing veins and their rupture after minor trauma.…”

“…In some cases, SDH could be secondary to intra-meningioma hemorrhage breaking through the tumor to the subdural spaces. The localization of the tumor at the cerebral convexity could be a risk factor for hemorrhage (6,8,11). …”

Transitional Meningioma with Intratumoural Bleed and Associated Subdural Haemorrhage: Case Report and a Review of Literature

“…Several predisposing factors have been identified in the literature and these include trauma, hypertension, anticoagulation therapy, Valsalva manoeuvre and pregnancy/post-partum [14][15][16][17][18][19][20]. The mechanisms causing haemorrhage in meningioma are still not fully understood; however many hypotheses have been proposed:…”