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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.71 no.6 São Paulo June 2013

https://doi.org/10.1590/0004-282X20130052 

Images In Neurology

Meningioma associated with non-traumatic subdural hematoma: an outstanding appearance of this common intracranial tumor

Meningioma intracraniano associado a hematoma subdural não traumático: uma apresentação excepcional deste tumor intracraniano frequente

Antônio José da Rocha1 

Nelson Saade2 

Adriano Zanon da Silva3 

1Section of Neuroradiology, Santa Casa de Misericórdia de São Paulo, São Paulo SP, Brazil

2Division of Neurosurgery, Santa Casa de Misericórdia de São Paulo, São Paulo SP, Brazil

3Department of Pathology, Santa Casa de Misericórdia de São Paulo, São Paulo SP, Brazil


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).

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 SDH 1,2 . Meningioma is generally located on the convexity; however, no particular subtype of this tumor seems to predispose to this complication 1,2 . We consider that herein reported imaging features might support the diagnosis before surgical approach.

References

1. 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. [ Links ]

2. 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. [ Links ]

Received: December 19, 2012; Accepted: December 28, 2012

Correspondence: Antônio José da Rocha; Rua Dr. Cesário Motta Junior 112; 01221-020 São Paulo SP - Brasil; E-mail: a.rocha@uol.com.br

Conflict of interest: There is no conflict of interest to declare.

Creative Commons License This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.