Acute, nontraumatic subdural hemorrhage as a presentation of meningioma: A report of two cases and literature review

Abstract

Meningiomas are the most common primary intracranial neoplasms. Their presentation is variable with many found incidentally after cranial imaging is performed for an unrelated reason. Although seizure or neurologic deficits may occur, presentation in the setting of acute hemorrhage is rare. Specifically, there are few reports of patients presenting with acute, nontraumatic subdural hemorrhage (anSDH). Here we describe two meningioma patients that presented to our institution with anSDH. We postulate that venous congestion results in subdural hemorrhage in meningioma patients since evidence of venous hypertension was visualized on vascular imaging for both patients that presented to our institution. Additionally, we present a comprehensive review of this clinical scenario. We identified 30 articles describing 36 cases of patients with meningiomas presenting with anSDH in the English literature. Most patients presented with acute neurological status changes and required urgent or emergent intervention to prevent secondary cerebral injury. Nearly all patients harbored grade 1 meningioma subtypes and 26/36 were located along a cerebral convexity. These patients present a clinical challenge as they often have emergent surgical needs and complete preoperative imaging is not always possible.

Keywords

• Meningioma
• Nontraumatic subdural hematoma
• Tumor hemorrhage
• Venous hypertension