Skip to main content

Advertisement

SpringerLink
Log in

Diagnostic neuroradiology of intracranial meningiomas presenting with hemorrhagic onset: a double center 14-year experience

  • Original Article
  • Published:
Emergency Radiology Aims and scope Submit manuscript

Abstract

Purpose

This study aims to increase awareness of the hemorrhagic presentation of intracranial meningiomas in the emergency department and present clues for neuroradiological diagnosis, which is crucial for pertinent management. We described the prevalence of hemorrhage in a large population of meningioma patients, with emphasis on clinical presentation, computed tomography (CT), magnetic resonance (MR), and digital subtraction angiography (DSA) findings.

Methods

This retrospective analysis has been performed at two reference institutions between January 2002 and December 2015, and includes 1304 patients with histologically proven newly diagnosed intracranial meningioma. Clinical features and neuroradiological findings of intracranial meningiomas presenting with hemorrhage have been reviewed.

Results

Twenty-four patients (1.8%, 16 females, 8 males, age range: 29–88 years) were found to have spontaneous hemorrhagic onset of the newly diagnosed meningioma. A sudden onset occurred in 23/24 patients. Sixteen patients showed isolated intralesional hemorrhage, four had subdural hematomas, and the remaining four presented combined intralesional and subarachnoid (n = 2) or intraventricular (n = 2) hemorrhages. In 13 patients, CT showed both the hemorrhage and the meningioma. In the other 11 patients, diagnosis was achieved by emergency or early surgery (n = 5), MRI (n = 5), and DSA (n = 1).

Conclusions

The presence of an underlying meningioma has to be considered in the differential diagnosis of spontaneous intracranial hemorrhage, although this is a rare event. CT, MRI, and occasionally DSA were useful to obtain the diagnosis; however, in up to a fifth of patients, this was achieved at surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Availability of data and materials

The data supporting the conclusions of this study are included within the published article.

Abbreviations

CT:

Computed tomography

CTA:

Computed tomography angiography

DSA:

Digital subtraction angiography

FLAIR:

Fluid-attenuated inversion recovery

MRI:

Magnetic resonance imaging

SWI:

Susceptibility-weighted imaging

References

  1. Claus EB, Bondy ML, Schildkraut JM, Wiemels JL, Wrensch M, Black PM (2005) Epidemiology of intracranial meningioma. Neurosurgery 57:1088–1095. https://doi.org/10.1007/s11060-010-0386-3

    Article  PubMed  Google Scholar 

  2. Kouyialis AT, Stranjalis G, Analyti R, Boviatsis EJ, Korfias S, Sakas DE (2004) Peritumoural haematoma and meningioma: a common tumour with an uncommon presentation. J Clin Neurosc 11:906–909. https://doi.org/10.1016/j.jocn.2004.02.014

    Article  CAS  Google Scholar 

  3. Wakai S, Yamakawa K, Manaka S, Takakura K (1982) Spontaneous intracranial hemorrhage caused by brain tumor: its incidence and clinical significance. Neurosurgery 10:437–444. https://doi.org/10.1227/00006123-198204000-00004

    Article  CAS  PubMed  Google Scholar 

  4. Pereira BJA, de Almeida AN, Paiva WS, de Aguiar PHP, Teixeira MJ, Marie SKN (2020) Assessment of hemorrhagic onset on meningiomas: systematic review. Clin Neurol Neurosurg. 199:106175. https://doi.org/10.1016/j.clineuro.2020

    Article  PubMed  Google Scholar 

  5. Niiro M, Ishimaru K, Hirano H, Yunoue S, Kuratsu J (2003) Clinico-pathological study of meningiomas with hemorrhagic onset. Acta Neurochir (Wien) 145:767–772. https://doi.org/10.1007/s00701-003-0089-z

    Article  CAS  PubMed  Google Scholar 

  6. Huang R, Su S, Yang Z, Wang H, Hong L, Chen L, Wu X, Zheng Y, Zhuang R, Liu Y (2022) Neuroradiologic findings and clinical features of meningiomas with spontaneous hemorrhagic onset: a single-center 10-year experience. World Neurosurg 162:e605–e615. https://doi.org/10.1016/j.wneu.2022.03.080

    Article  PubMed  Google Scholar 

  7. Lefranc F, Nagy N, Dewitte O, Baleriaux D, Brotchi J (2001) Intracranial meningiomas revealed by non-traumatic subdural haematomas A series of four cases. Acta Neurochr (Wien) 143:977–83. https://doi.org/10.1007/s007010170002

    Article  CAS  Google Scholar 

  8. Worm PV, Ferreira MP, Ferreira NP, Cechetti F (2009) Subdural haematoma in a patient with meningioma. Arq Neuropsiquiatr 67:308–310. https://doi.org/10.1590/s0004-282x2009000200028

    Article  PubMed  Google Scholar 

  9. Modesti LM, Binet EF, Collins GH (1976) Meningiomas causing spontaneous intracranial hematomas. J Neurosurg 45:437–441. https://doi.org/10.3171/jns.1976.45.4.0437

    Article  CAS  PubMed  Google Scholar 

  10. Kleihues P, Louis DN, Scheithauer BW, Rorke LB, Reifenberger G, Burger PC, Cavenee WK (2002) The WHO classification of tumors of the nervous system. J Neuropathol Exp Neurol Mar;61(3):215–25; discussion 226–9. https://doi.org/10.1093/jnen/61.3.215.

  11. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, Scheithauer BW, Kleihues P (2007) The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 114(2):97–109. https://doi.org/10.1007/s00401-007-0243-4

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kothbauer P, Jellinger K, Flament H (1979) Primary brain tumors presenting as spontaneous intracerebral hemorrhage. Acta Neurochir (Wien) 49:35–45. https://doi.org/10.1007/BF01809172

    Article  CAS  PubMed  Google Scholar 

  13. Wakai S, Fukushima T, Teramoto A, Sano K (1981) Pituitary apoplexy: its incidence and clinical significance. J Neurosurg 55:187–193. https://doi.org/10.3171/jns.1981.55.2.0187

    Article  CAS  PubMed  Google Scholar 

  14. Helle TL, Conley FK (1980) Hemorrhage associated with meningioma: a case report and review of the literature. J Ncurol Neurosurg Psychiatry 43:725–729. https://doi.org/10.1136/jnnp.43.8.725

    Article  CAS  Google Scholar 

  15. Gitto L, Bolino G, Cina SJ (2018) Sudden unexpected deaths due to intracranial meningioma: presentation of six fatal cases, review of the literature, and a discussion of the mechanisms of death. J Forensic Sci 63(3):947–953. https://doi.org/10.1111/1556-4029.13626

    Article  PubMed  Google Scholar 

  16. Martinez-Lage JF, Poza M, Martinez M, Esteban JA, Antunez MC, Sola J (1991) Meningiomas with hemorrhagic onset Acta Neurochir (Wien) 110:129–132. https://doi.org/10.1007/BF01400680

    Article  CAS  PubMed  Google Scholar 

  17. Bruno MC, Santangelo M, Panagiotopoulos K, Piscopo GA, Narciso N, Del Basso De Caro MI, Briganti F, Cerillo A (2003) Bilateral chronic subdural hematoma associated with meningioma. Case report and review of the literature. J Neurosurg Sci Dec;47(4):215-27; discussion 227

  18. Halalmeh DR, Alrashdan M, Kharouf M, Sbeih I, Molnar PT, Moisi MD (2022) Brain meningiomas manifesting as intracranial hemorrhage: comprehensive systematic review and report of the first case of hemorrhagic meningiomatosis. World Neurosurg Nov 2:S1878–8750(22)01530–3. https://doi.org/10.1016/j.wneu.2022.10.113.

  19. Chaskis C, Raftopoulos C, Noterman J, Flament-Durand J, Brotchi J (1992) Meningioma associated with subdural haematoma: report of two cases and review of the literature. Clin Neurol Neurosurg 94:269–274. https://doi.org/10.1016/0303-8467(92)90103-a

    Article  CAS  PubMed  Google Scholar 

  20. Nery B, Costa RAF, Pereira LCT et al (2019) Spontaneous subdural hematoma associated with microcystic meningioma: first case report in the literature. Br J Neurosurg 33(4):428–431. https://doi.org/10.1080/02688697.2017.1346172

    Article  PubMed  Google Scholar 

  21. Deprez FC, Finet P, Raftopoulos C, Duprez T (2012) Recurrent acute subdural bleeding as a rare complication of a hemorrhagic non malignant meningioma. JBR-BTR 95:309–312. https://doi.org/10.5334/jbr-btr.660

    Article  CAS  PubMed  Google Scholar 

  22. Chen JW, U HS, Grafe MR (1992) Unsuspected meningioma presenting as a subdural haematoma. J Neurol Neurosurg Psychiatry 55:167-8. https://doi.org/10.1136/jnnp.55.2.167-a

  23. Ito Y, Nakajima M2, Watari M, Sakamoto T, Hashimoto Y, Tajiri S, Takada A, Ando Y (2015) Intratumoral hemorrhage in a patient with malignant meningioma under anticoagulant therapy. J Stroke Cerebrovasc Dis 24:e91-2. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.11.008

  24. Pressman E, Penn D, Patel NJ (2020) Intracranial hemorrhage from meningioma: 2 novel risk factors. World Neurosurg 135:217–221. https://doi.org/10.1016/j.wneu.2019.10.173

    Article  PubMed  Google Scholar 

  25. Prickett JT, Klein BJ, Busch CM, Cuoco JA, Apfel LS, Marvin EA (2018) Rapidly expanding lateral ventricular meningioma presenting with intraventricular hemorrhage following remote whole brain radiation and stereotactic radiosurgery. J Neurol Surg Rep 79:e14–e18. https://doi.org/10.1055/s-0038-1637006

    Article  PubMed  PubMed Central  Google Scholar 

  26. Hu S, Zhang Y, Sun Y, Yu Y, Wang J, Dai H, Sun F, Hu C (2018) Lung metastases from intracranial bleeding meningioma: a case report. Medicine (Baltimore) 97:e0457. https://doi.org/10.1097/MD.0000000000010457

    Article  PubMed  Google Scholar 

  27. Moon JS, Cha SH, Cho WH (2019) Lateral ventricular meningioma presenting with intraventricular hemorrhage. Brain Tumor Res Treat 7:151–155. https://doi.org/10.14791/btrt.2019.7.e41

    Article  PubMed  PubMed Central  Google Scholar 

  28. SadeghMasoudi M, Zafarshamspour S, Ghasemi-Rad M, Soleimani N, Rakhsha A, Lincoln C (2019) Acute subdural hemorrhage of a convexity meningioma in the postpartum period; case report and literature review. Bull Emerg Trauma 7:324–329. https://doi.org/10.29252/beat-0703018

    Article  Google Scholar 

  29. Renowden SA, Hourihan MD (1992) Case report: acute subdural haematoma an unusual presentation of a meningioma. Clin Radiol 45:351–352. https://doi.org/10.1016/s0009-9260(05)80094-7

    Article  CAS  PubMed  Google Scholar 

  30. Popovic EA, Lyons MK, Scheithauer BW, Marsh WR (1994) Mast cell-rich convexity meningioma presenting as chronic subdural haematoma: case report and review of the literature. Surg Neurol 42:8–13. https://doi.org/10.1016/0090-3019(94)90242-9

    Article  CAS  PubMed  Google Scholar 

  31. Pozzi M, Dario A, Marra A, Scamoni C, Dorizzi A (1993) Associated chronic subdural haematoma and meningeal neoplasm. Two case reports J Neurosurg Sci 37:113–117

    CAS  PubMed  Google Scholar 

  32. Walsh JW, Winston KR, Smith T (1977) Meningioma with subdural hematoma. Surg Neurol 8:293–295

    CAS  PubMed  Google Scholar 

  33. Ravindran K, Gaillard F, Lasocki A (2017) Spontaneous subdural hemorrhage due to meningioma in the post-partum setting. J Clin Neurosci 39:77–79. https://doi.org/10.1016/j.jocn.2016.12.012

    Article  PubMed  Google Scholar 

  34. Aloraidi A, Abbas M, Fallatah B, Alkhaibary A, Ahmed ME, Alassiri AH (2019) Meningioma presenting with spontaneous subdural hematoma: a report of two cases and literature review. World Neurosurg Apr 1:S1878–8750(19)30928–3. https://doi.org/10.1016/j.wneu.2019.03.248.

  35. Suzuki Y, Fujimoto M, Kawakita F, Asakura F, Murata H, Morooka Y, Suzuki H (2018) Tiny falx meningioma causing massive interhemispheric subdural hematoma: a case report. NMC Case Rep J 9(5):51–55. https://doi.org/10.2176/nmccrj.cr.2017-0091

    Article  Google Scholar 

  36. Wang HC, Wang BD, Chen MS, Li SW, Chen H, Xu W, Zhang JM (2016) An underlying pathological mechanism of meningiomas with intratumoral hemorrhage: undifferentiated microvessels. World Neurosurg 94:319–327. https://doi.org/10.1016/j.wneu.2016.07.042

    Article  PubMed  Google Scholar 

  37. Grasso G, Landi A, Alafaci C (2016) Pathogenetic mechanisms of intratumoral hemorrhage in meningioma: the role of microvascular differentiation. Nov;95:599-600. https://doi.org/10.1016/j.wneu.2016.07.118

  38. Fu Z, Xu K, Xu B, Qu L, Yu J (2011) Lateral ventricular meningioma presenting with intraventricular hemorrhage: a case report and literature review. Int J Med Sci 8:711–716. https://doi.org/10.7150/ijms.8.711

    Article  PubMed  PubMed Central  Google Scholar 

  39. Schartz D, D’Agostino E, Makler V, Hickey WF, Bauer DF (2019) Third ventricle World Health Organization Grade II meningioma presenting with intraventricular hemorrhage and obstructive hydrocephalus: a case report and literature review. Surg Neurol Int 10:73. https://doi.org/10.25259/SNI-90-2019

    Article  PubMed  PubMed Central  Google Scholar 

  40. Saloner D, Uzelac A, Hetts S, Martin A, Dillon W (2010) Modern meningioma imaging techniques. J Neurooncol 99:333–340. https://doi.org/10.1007/s11060-010-0367-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Zhao X, Yu RT, Li JS, Xu K, Li X (2013) Clinical value of multi-slice 3-dimensional computed tomographic angiography in the preoperative assessment of meningioma. Exp Ther Med 6:475–478. https://doi.org/10.3892/etm.2013.1147

    Article  PubMed  PubMed Central  Google Scholar 

  42. Iacobucci M, Danieli L, Visconti E, Maresca M, Anile C, Colosimo C, Pedicelli A (2017) Preoperative embolization of meningiomas with polyvinyl alcohol particles: the benefits are not outweighed by risks. Diagn Interv Imaging 98:307–314. https://doi.org/10.1016/j.diii.2016.08.006

    Article  CAS  PubMed  Google Scholar 

  43. Basil G, Urakov T, Knudsen MG, Morcos J (2018) Jugular tubercle meningioma with hemorrhagic conversion mimicking a ruptured thrombosed giant vertebrobasilar aneurysm. World Neurosurg 119:108–112. https://doi.org/10.1016/j.wneu.2018.07.159

    Article  PubMed  Google Scholar 

  44. Cioni M, Bogoni M, Chomiski C, Maschke L, Ratti MAS, Teixeira BCA (2019) Dural metastasis of prostate adenocarcinoma with spontaneous subdural hematoma: an unusual mimicker of meningioma. Arq Neuropsiquiatr 77:595–596. https://doi.org/10.1590/0004-282X20190086

    Article  PubMed  Google Scholar 

  45. Matsuoka G, Eguchi S, Ryu B, Tominaga T, Ishikawa T, Yamaguchi K, Kawamata T (2019) Treatment strategy for recurrent hemorrhage from meningioma: case report and literature review. World Neurosurg 5: S1878–8750(18)32947–4. https://doi.org/10.1016/j.wneu.2018.12.124.

Download references

Author information

Authors and Affiliations

  1. Unit of Neuroimaging, Diagnostic and Functional Neuroradiology, Clinical Department of Neurological and Motor Sciences, Azienda Ospedaliero-Universitaria Senese, Santa Maria Alle Scotte National Health System and University Hospital, Tuscany, Siena, Italy

    Alfonso Cerase

  2. Department of Radiology, Diagnostic and Interventional Neuroradiology, Kingston Health Science Centre, Queen’s University, Kingston, ON, Canada

    Donatella Tampieri

  3. Unit of Pathology, Clinical Department of Oncology, Azienda Ospedaliero-Universitaria Senese and Department of Medicine, Surgery, and Neurosciences, University of Siena, Santa Maria Alle Scotte National Health System and University Hospital, Tuscany, Siena, Italy

    Clelia Miracco

  4. Department of Diagnostic Imaging, Section of Neuroradiology, San Donato National Health System Hospital, Pietro Nenni Street, 52100, Arezzo, Tuscany, Italy

    Irene Grazzini

Authors
  1. Alfonso Cerase
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Donatella Tampieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Clelia Miracco
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Irene Grazzini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Irene Grazzini.

Ethics declarations

Ethical approval

Ethical approval was waived in view of the retrospective nature of the study, and all the procedures being performed were part of the routine care.

Informed consent

Informed consent for each diagnostic procedure was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Key Points

• 1.8% of intracranial meningiomas were found to show hemorrhagic presentation.

• Most hemorrhagic meningiomas can be reliably diagnosed by neuroradiology.

• Neuroradiological differential diagnosis of spontaneous intracranial hemorrhage includes meningioma.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cerase, A., Tampieri, D., Miracco, C. et al. Diagnostic neuroradiology of intracranial meningiomas presenting with hemorrhagic onset: a double center 14-year experience. Emerg Radiol 30, 175–185 (2023). https://doi.org/10.1007/s10140-023-02115-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10140-023-02115-y

Keywords

Search

Navigation