A 52-year-old man presented with a sudden progressive headache complicated on admission by a left hemiparesis. No history of trauma, alcohol abuse or concurrent systemic disease was confirmed. Imaging investigation depicted acute subdural hematoma (SDH) associated with an extra-axial tumor (Figure).
Meningioma associated with non-traumatic subdural hematoma. Axial computed tomography scan (A) showed heterogeneous subdural hemorrhage (arrowheads) associated with a dural attached tumor on right parietal convexity (asterisk). Axial T1 weighted image (B) and T2 gradient echo sequence* (C) distinguished both extra-axial contents, clot (arrowheads) and tumor (*). Comparative axial T1 weighted image post-gadolinium administration (D) depicted intense tumor enhancement (*). No enhancement was noticed on subdural hemorrhage (arrowheads). Surgical pathology (hematoxylin and eosine staining) confirmed a meningioma (grade I) with prevalent features of the meningothelial subtype associated with hemorrhage (E).
A combination of several pathogenetic mechanisms has been hypothesized to explain this very rare association of intracranial meningiomas with spontaneous SDH11. Di Rocco F, Mannino S, Puca A, Lauriola L, Pompucci A. Intracranial meningiomas associated with non-traumatic chronic subdural hematoma. Acta Neurochir 2006;148:1097-1102.,22. Lefranc F, Nagy N, Dewitte O, Baleriaux D, Brotchi J. Intracranial meningiomas revealed by non-traumatic subdural haematomas: a series of four cases. Acta Neurochir 2001;143:977-982.. Meningioma is generally located on the convexity; however, no particular subtype of this tumor seems to predispose to this complication11. Di Rocco F, Mannino S, Puca A, Lauriola L, Pompucci A. Intracranial meningiomas associated with non-traumatic chronic subdural hematoma. Acta Neurochir 2006;148:1097-1102.,22. Lefranc F, Nagy N, Dewitte O, Baleriaux D, Brotchi J. Intracranial meningiomas revealed by non-traumatic subdural haematomas: a series of four cases. Acta Neurochir 2001;143:977-982.. We consider that herein reported imaging features might support the diagnosis before surgical approach.
References
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1Di Rocco F, Mannino S, Puca A, Lauriola L, Pompucci A. Intracranial meningiomas associated with non-traumatic chronic subdural hematoma. Acta Neurochir 2006;148:1097-1102.
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2Lefranc F, Nagy N, Dewitte O, Baleriaux D, Brotchi J. Intracranial meningiomas revealed by non-traumatic subdural haematomas: a series of four cases. Acta Neurochir 2001;143:977-982.
Publication Dates
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Publication in this collection
June 2013
History
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Received
19 Dec 2012 -
Accepted
28 Dec 2012
