Tiny Falx Meningioma Causing Massive Interhemispheric Subdural Hematoma: A Case Report

Abstract

Bleeding from meningiomas is well known, but massive subdural hemorrhage from a very small meningioma is rare. A 61-year-old woman presented with a sudden-onset headache and slight right hemiparesis without a history of trauma. Computed tomographic scan showed bilateral acute/subacute interhemispheric subdural hematoma, but contrast-enhanced computed tomography (CT) scan, non-enhanced magnetic resonance imaging (MRI) and digital subtraction angiography failed to detect the cause. The hematoma was conservatively treated. Three weeks later, CT scans showed a vestige of the hematoma along the falx. However, repeated angiogram revealed a tumor stain on the falx supplied by the middle meningeal arteries, leading to the tentative diagnosis of meningioma. The tumor was removed and histologically diagnosed as angiomatous meningioma. It is rare that falx meningioma causes massive interhemispheric subdural hematoma, and the diagnosis of the causative lesion is challenging if tumor is small. We review the literature and discuss the characteristics.

A convexity meningioma presenting with an acute subdural hematoma

“…Pathologically, we found that the most common type is meningothelial meningioma (44%, 20 out of 45 cases) followed by transitional meningioma and angioblastic meningioma (17%, 8 cases). [ 1 , 6 , 7 , 9 - 11 , 13 - 15 , 18 , 19 ] Based on the above results, a pathological type and a location in our case followed the trend obtained from the 45 reported cases of meningiomas with ASDH manifestations.…”

“…[ 7 , 9 , 12 ] A PubMed search using the keywords “meningioma,” “subdural,” and “hematoma” identified only 45 reported cases [ Table 1 ]. [ 1 , 6 , 7 , 9 - 11 , 13 - 15 , 18 , 19 ] Wakai et al . previously reported hemorrhagic manifestations in 1.3% of all meningiomas in their institute.…”

“…A detailed PubMed search identified only 45 published cases of meningiomas associated with hemorrhagic manifestations. [ 1 , 6 , 7 , 9 - 11 , 13 - 15 , 18 ] We report on the case of a 67-year-old man with a benign meningioma discovered due to an ASDH, and we follow our case with a thorough literature review.…”

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

“…[ 14 ] Among them, falx meningioma is exceedingly rare; to date, only eight cases, including this case, have been reported [ Table 1 ]. [ 4 , 6 , 9 , 12 , 13 , 14 , 17 , 18 ] Among the reported cases, six involved female patients (75%) and the mean age was 68 years (range, 61–78 years). Most cases of bleeding occur when the tumor is first identified, and only in this case, the tumor was identified before bleeding.…”

“…[1,10] Only eight cases of falx meningioma with acute subdural hematoma (ASDH) have been reported. [4,6,9,12,13,17,18] is is the first case report of ASDH with rapid growth of a falx meningioma found during imaging follow-up.…”