Atypical Meningioma Manifesting with Spontaneous Perilesional Hemorrhage: case report and review of the literature

Introduction: Meningiomas are the most common benign intracranial tumor and usually are manifested with symptoms from a slow growing neoplastic mass. Acute presentation with intracranial hemorrhage is extremely rare. Case Presentation: A 54 years-old man was admitted at the emergency department presenting sudden onset of severe headache, evolving rapidly to deterioration of consciousness and left hemiplegia. Cranial computed tomography scan revealed a large right frontal mass associated with perilesional volumous hemorrhage, and compression of basal cisterns and deviation of midline structures. Brain magnetic resonance confirmed the previous findings and also showed that the neoplastic lesion was a probable meningioma with a frontal convexity of dural tail and relevant adjacent brain edema. The patient was taken to the operating room and the meningioma and the adjacent hemorrhagic lesion were completely removed through a large right frontal craniotomy. After two months of surgical treatment, he remains with left side partial motor deficit. Anatomopathological analysis revealed that the neoplastic lesion was an atypical meningioma (WHO Grade II). Conclusion: Parenchymal hemorrhage from convexity meningioma is a complex condition that must be treated urgently. Early suspicion, correct diagnosis and urgent treatment of the condition all together seems to play a key role reducing mortality and morbidity.