Spontaneous Intracranial Haematomas Caused by Neoplasms

Abstract

We report about 50 patients with spontaneous intracerebral haematomas (ICH) caused by intracranial neoplasms to assess the underlying histological condition, their presentation on admission, diagnostic work-up, treatment, histological diagnosis, and clinical outcome. These patients were identified in a prospective series of 2041 patients with intracranial neoplasms and 692 patients with spontaneous ICH, which were both consecutively collected over a nine-year-period. The frequency of ICH in patients with intracranial neoplasms was 2.4%. The frequency of tumour related ICH in the ICH group was 7.2%. The leading cause of tumour related ICH were metastases of extracranial origin (n = 18; 36%), followed by glioblastoma multiforme (n = 15; 30%). Nine patients (18%) had benign primary intracranial neoplasms. On admission 18 patients were somnolent (36%) and 14 patients (28%) were comatose. In 29 cases (58%) ICH was the first clinical sign of neoplastic disease, while in 21 patients (42%) a malignant tumour was already known. We operated on 45 patients (90%), four patients (8%) were not operated on because of poor clinical condition and died, one patient refused surgical treatment. Six patients (12%) died despite surgery. This series confirms the importance of a proper neuroradiological and clinical work-up of patients with suspected tumour related ICH followed by operative treatment and histological confirmation of the diagnosis. This is supported by the fact that 18% of patients had prognostically favourable intracranial tumours which would not otherwise have been adequately treated.

A comprehensive analysis of vascular complications in 3,889 glioma patients from the German Glioma Network

“…The frequency of non-postoperative ICH in glioma varies from 2-25% in the literature [10], [22], [27]. The postoperative risk for ICH is about 2-5% [6], [23].…”

Comparison of O-(2-18F-Fluoroethyl)-l-Tyrosine and l-3H-Methionine Uptake in Cerebral Hematomas

“…The primary brain tumors that have a propensity to present with hemorrhage include high-grade astrocytomas, oligodendrogliomas, and mixed oligoastrocytomas (1). In pathologic and radiologic studies, the frequency of spontaneous ICH in intracranial neoplasms ranges from 1.4% to 10% (2). 18 F-fluoroethyl-L-tyrosine ( 18 F-FET) is a well-established amino acid tracer for brain tumor diagnostics with PET that is applicable in a satellite concept such as 18 F-FDG (3)(4)(5)(6).…”

Cerebral glioblastoma mimicking a cavernous malformation: A case report and literature review

“…Suppression of the tissue factor-dependent coagulation cascade may cause glioblastoma-associated ICH [6] . Finally, intratumoral arteriovenous fistulae may also be a mechanism for the pathogenesis of tumor-associated hemorrhage [7] . In this case, the hemorrhage could have originated from the numerous small abnormal vessels, which rupture easily.…”

“…Nevertheless, some distinctive characteristics of tumor-related ICH on images may aid in diagnosis. Atypical position, irregular shape, heterogeneous signal, and multiple hemorrhage positions suggest that intracranial hematomas may be caused by neoplasms [7,8] . Most of tumor-related hemorrhages are intraparenchymal and rarely rupture into the subarachnoid space.…”