Acute subdural hematoma associated with disruption of tumor vessels due to rapid growth of falx meningioma: A case report and literature review

Abstract

Background: Meningiomas associated with acute subdural hematoma (ASDH) are rare. The rapid growth of meningiomas has been shown to be one of the mechanisms underlying bleeding. We report the first case of ASDH during an imaging follow-up for the rapid growth of a falx meningioma. Case Description: A 77-year-old woman was diagnosed with an incidental tumor along the right falx cerebri 3 years before bleeding. The follow-up magnetic resonance imaging (MRI) after 3 years showed that the tumor volume had rapidly increased from 4.31 cm3 to 22.27 cm3. The blood vessels around the tumor were stretched. The patient was scheduled to undergo tumor removal surgery. However, the patient experienced a sudden onset of disturbance of consciousness and was transferred to our hospital. On arrival, her Glasgow Coma Scale (GCS) score was 6 (E1V1M4) and right hemiplegia was observed. The patient had no history of traumatic events. Computed tomography (CT) showed left hemispheric and interhemispheric ASDH. Digital subtraction angiography revealed neither tumor staining nor abnormal vessels. Gross total tumor removal and hematoma evacuation were performed. There were no obvious active intraoperative bleeding points. The pathologic diagnosis was meningioma, the World Health Organization Grade I. Postoperative course revealed a GCS score of 10 (E4V1M5) and she was transferred to a rehabilitation hospital. Conclusion: The disruption of tumor vessels due to the rapid growth of meningiomas may be a cause of bleeding. Incidental falx meningiomas with stretched tumor vessels due to rapid growth could indicate the need for early surgery.

Fatal convexity and interhemispheric acute subdural hematoma from a falx meningioma: A case report

“…They include the following: (1) disruption of tumor vessels due to tumor growth; (2) disruption of bridging veins due to tumor growth; (3) direct invasion of tumor cells into blood vessels; (4) release of vasoactive substances by tumor cells; (5) disruption of bridging veins due to local venous hypertension caused by a secondary condition, such as Valsalva maneuver or cough; and (6) anticoagulant or antiplatelet medications, blood dyscrasias, or hypertension. [ 6 , 14 , 18 , 19 , 20 , 22 , 23 ]…”

Acute subdural hematoma caused by hemorrhagic falx meningioma: A case report and review of the literature

“…Furthermore, among hemorrhagic meningiomas, the presence of subdural hematoma is observed in only a mere 18% [16] . Hemorrhagic falx meningiomas associated with acute subdural hematoma have been reported in 9 cases including the present case in relevant English-language literature ( Table 1 ) [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] . Among them, 7 cases are female, with the median age of 64 (range: 61-78) years.…”

“…We compare meningiomas with subdural hematoma to those without bleeding ( Table 2 ) [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , 13 , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] . In cases of meningiomas with subdural hematoma, the median age is 62 (range: 4 m-85 y) years.…”

“…Hemorrhagic meningioma with subdural hematoma is even more rare [3] . Hemorrhagic falx meningiomas associated with acute subdural hematoma have been reported in 8 cases [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] . We present here a ninth case.…”

Spontaneous Intracranial Hemorrhage Associated With an Intracranial Meningioma

“…Attempts have been made to describe the pathophysiological mechanisms of hemorrhage. Some mechanisms proposed in the literature are related to the characteristics of the tumor vasculature due to rapid angiogenesis resulting in vessels with thinned, friable vascular walls, associated with direct vascular invasion by tumor cells like stretching subdural veins [3][4][5][6]. These characteristics predispose to an increased risk of bleeding due to minor trauma, hypertension, blood dyscrasias, and anticoagulation.…”