Intracranial haemorrhage from a meningioma in a patient receiving aspirin prophylaxis: a case report

Abstract

A case of acute subdural haematoma originating spontaneously from an angiomatous meningioma in a patient receiving prophylactic aspirin therapy is presented. To the best of our knowledge no comparable case and no discussion of possible complications of aspirin prophylaxis in patients with brain tumours have been published. Possible reasons and clinical significance of this complication are discussed. This observation questions the suitability of aspirin as prophylaxis for vascular disease in patients with meningiomas.

Low-dose aspirin prophylaxis and risk of intracranial hemorrhage in patients older than 60 years of age with mild or moderate head injury: a prospective study

“…Aspirin has been associated with several occurrences of nontraumatic spinal epidural hematoma 3,5 and spontaneous bleeding from an intracranial tumor. 15 Aspirin is also associated with an increased risk for the development of a chronic subdural hematoma 10,16 and postoperative intracranial hemorrhage. 8,9 It is well known that the older population is at greater risk for head injury.…”

Spontaneous haemorrhage into a convexity meningioma

“…In a recent publication, the association of antiplatelet therapy with hemorrhage from a convexity meningioma was described [5]. This article also highlights the potential dangers of anticoagulation or antiplatelet therapy in a patient with a meningioma.…”

“…When hemorrhage does occur, it is usually subdural, subarachnoid, or intracerebral [3][4][5]. Hemorrhage within a meningioma itself is exceptional, and is usually associated with anticoagulation therapy or pre-operative embolization [1][2][3][4].…”

Meningiomas associated with hemorrhage: A report of two cases with a review of the literature

“…The mechanism of bleeding related to meningioma is unclear, as revealed by various suggestions. These include compensatorily enlarged feeding blood vessels with weakening and rupture of walls, 23 cerebral edema and obstruction of veins leading to hemorrhagic infarct, 30 , 36 excessive blood vessels forming an angiomatous com‐ponent with bleeding tendency, 31 , 39 , 44 , 47 , 58 , 62 stretching and rupture of blood vessels such as of subdural bridging veins by the expanding meningioma, 6 direct vascular invasion by the tumor cells, 20 , 44 , 52 , 59 trauma to the head, 6 , 27 , 67 effects of therapeutic embolization in order to diminish operative hemorrhage, 70 , 72 , 86 and aspirin prophylaxis in transient cerebral ischemia 92 . Endothelial hyperplasia leading to obliteration of a vessel and distal necrosis of its wall with consequent bleeding was also hypothesized 41 , 44 .…”

“…Endothelial hyperplasia leading to obliteration of a vessel and distal necrosis of its wall with consequent bleeding was also hypothesized 41 , 44 . Moreover, degeneration of the vascular walls associated with hypertension, 7 , 91 , 92 diabetes mellitus, 7 , 96 and radiotherapy 77 have also been proposed as the cause of hemorrhage, as was anti‐coagulant therapy 49…”