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Intracranial Malignant Glioma Presenting as Subarachnoid Hemorrhage

Published online by Cambridge University Press:  02 December 2014

Stephen Hentschel  and
Brian Toyota
Stephen Hentschel
Affiliation:
Department of Surgery, Division of Neurosurgery, Vancouver Hospital and Health Sciences Centre, University of British Columbia, Vancouver, BC Canada
Brian Toyota
Affiliation:
Department of Surgery, Division of Neurosurgery, Vancouver Hospital and Health Sciences Centre, University of British Columbia, Vancouver, BC Canada
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Abstract

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Objective:

Cerebral aneurysms are the predominant cause of spontaneous subarachnoid hemorrhage (SAH). However, if an aneurysmal cause has been excluded, there remains but a short list of other potential etiologies. Cerebral neoplasms are clearly on this list but are most commonly meningiomas or metastatic lesions. This article details a case of a neoplasm that presented exclusively with SAH.

Clinical Presentation:

A 40-year-old male presented with a SAH with normal cerebral angiography. The initial magnetic resonance image revealed a lesion in the right insula thought to be resolving hemorrhage. Subsequent images, however, revealed the mass to be enlarging.

Intervention:

Craniotomy and resection of the lesion established a diagnosis of a malignant oligodendroglioma.

Conclusion:

An affirmation is made that patients experiencing ’angiographically-negative’ SAH should undergo MRI, occasionally on a serial basis, to exclude other etiologies for hemorrhage, including neoplasia.

Résumé:

RÉSUMÉ: Objectif:

Les anévrismes cérébraux sont la cause première d’hémorragie sous-arachnoïdienne spontanée. Cependant, si une cause anévrismale a été exclue, un petit nombre d’autres étiologies potentielles doivent être considérées, dont les néoplasies cérébrales. Parmi celles-ci les plus fréquentes sont les méningiomes et les lésions métastatiques. Cet article présente un cas de néoplasie dont la présentation initiale était une hémorragie sous-arachnoïdienne sans autre manifestation clinique.

Présentation clinique:

Un homme âgé de 40 ans a présenté une hémorragie sousarachnoïdienne avec une angiographie normale. L’imagerie par résonance magnétique (IRM) a montré une lesion dans l’insula droite qu’on a pensé être une hémorragie en voie de résolution. Des images subséquentes ont cependant montré une augmentation de volume de la masse.

Intervention:

La résection de la lésion par crâniotomie a montré qu’il s’agissait d’un oligodendrogliome malin.

Conclusion:

Les patients qui présentent une hémorragie sousarachnoïdienne et dont l’angiographie est négative devraient subir une IRM sériée au besoin, pour exclure d’autres étiologies de l’hémorragie, dont une néoplasie.

Type
Case Report
Information
Canadian Journal of Neurological Sciences , Volume 30 , Issue 1 , February 2003 , pp. 63 - 66
Copyright
Copyright © The Canadian Journal of Neurological 2003

References

1. Chalif, D, Black, K, Rosenstein, D. Intradural spinal cord tumour presenting as subarachnoid hemorrhage: magnetic resonance imaging diagnosis. Neurosurgery 1990;27:631–634.CrossRefGoogle ScholarPubMed
2. Van Gijn, J, Van Dongen, K, Vermeulen, M, Hijdra, A. Perimesencephalic hemorrhage: a nonaneurysmal and benign form of subarachnoid hemorrhage. Neurology 1985;35:493–497.CrossRefGoogle ScholarPubMed
3. Locksley, H, Sahs, A, Sandler, R. Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage III. Subarachnoid hemorrhage unrelated to intracranial aneurysm and AV malformation . A study of associated diseases and prognosis. J Neurosurg 1966;24:1034–1056.Google Scholar
4. Courville, C, (ed). Pathology of the central nervous system. Mountain View, CA: Pacific Press Publishing Association; 1937.Google Scholar
5. Spetzger, U, Mull, M, Sure, U, Gilsbach, J. Subarachnoid and intraventricular hemorrhage caused by hypernephroma metastasis, accompanied by innocent bilateral posterior communicating artery aneurysms. Surg Neurol 1995;44:275–278.Google Scholar
6. Glass, B, Abott, K. Subarachnoid hemorrhage consequent to intracranial tumors. Arch Neurol Psych 1955;73:369–379.Google Scholar
7. Oldberg, E. Hemorrhage into gliomas: a review of eight hundred and thirty-two consecutive verified cases of glioma. Arch Neurol 1933;30:1061–1073.CrossRefGoogle Scholar
8. Batjer, H, Kopitnik, TA, Friberg, L. Spontaneous Intracerebral and Intracerebellar Hemorrhage. In: Youmans, J, editor. Youmans’ Neurological Surgery. W.B. Saunders Company; 1997.Google Scholar
9. Rinkel, G, Wijdicks, E, Hasan, D, et al. Outcome in patients with subarachnoid haemorrhage and negative angiography according to pattern of haemorrhage on computed tomography. Lancet 1991;338:964–968.CrossRefGoogle ScholarPubMed
10. Dagi, TF, Maccabe, JJ. Metastatic trophoblastic disease presenting as a subarachnoid hemorrhage: report of two cases and review of the literature. Surg Neurol 1980;14:175–184.Google ScholarPubMed
11. Kondziolka, D, Bernstein, M, Resch, L, et al. Significance of hemorrhage into brain tumors: clinicopathological study. J Neurosurg 1987;67:852–857.CrossRefGoogle ScholarPubMed
12. Foster, D, Steiner, L, Hakanson, S, Bergvall, U. The value of repeat panangiography in cases of unexplained subarachnoid hemorrhage. J Neurosurg 1978;48:712–716.Google Scholar
13. Renowden, S, Molyneux, A, Anslow, P, Byrne, J. The value of MRI in angiogram-negative intracranial hemorrhage. Neuroradiology 1994;36:422–425.CrossRefGoogle Scholar
14. Perret, L, Bull, J. Some aspects of subarachnoid hemorrhage: a symposium III. The accuracy of radiology in demonstrating ruptured intracranial aneurysms . Br J Radiol 1959;32:85–92.Google Scholar
15. Nutt, S, Patchell, R. Intracranial hemorrhage associated with primary and secondary tumors. Neurosurg Clin N Am 1992;3:591–599.Google Scholar
16. Susuki, S, Kayama, T, Sakurai, Y. Subarachnoid hemorrhage of unknown cause. Neurosurgery 1987;21:310–313.CrossRefGoogle Scholar
17. Liwnicz, BH, Wu, SZ, Tew, JM Jr. The relationship between the capillary structure and hemorrhage in gliomas. J Neurosurg 1987; 66(4):536–541 Google Scholar
18. Helle, T, Conley, F. Hemorrhage associated with meningioma: a case report and review of the literature. J Neurol Neurosurg Psych 1980;43:725–729.Google Scholar
19. Askenasy, H, Behmoaram, A. Subarachnoid hemorrhage in meningiomas of the lateral ventricle. Neurology 1960;10:484–489.CrossRefGoogle ScholarPubMed
20. West, H, Mani, R, Eisenberg, R. Normal cerebral arteriography in patients with spontaneous subarachnoid hemorrhage. Neurology 1977;27:592–594.CrossRefGoogle ScholarPubMed