Case report
Spontaneous subdural haemorrhage due to meningioma in the post-partum setting

https://doi.org/10.1016/j.jocn.2016.12.012Get rights and content

Highlights

  • Meningiomas are typically asymptomatic tumours.

  • Haemorrhage from meningioma is a rare complication.

  • Haemorrhagic meningioma, in the post-partum period, is described for the first time here.

Abstract

An acute presentation of a meningioma with spontaneous haemorrhage is rare, with mechanisms of haemorrhage remaining unclear. Here, we present a case of a meningioma causing spontaneous intra-tumoural and subdural haemorrhage in the post-partum setting, to our knowledge not previously described, with review of pertinent literature.

Introduction

Meningiomas are slow-growing tumours and often asymptomatic until discovered incidentally on neuroimaging [1]. In patients who are symptomatic, meningiomas typically present with mass effect, seizure disorders, focal neurological deficits or cognitive decline [2]. Acute spontaneous intra- and extra-tumoural haemorrhage from a meningioma represents a rare phenomenon and, to our knowledge, has not been previously described in the post-partum period. Here, we report the case of a 36 year-old female, nine days post-partum, who presented with a spontaneous haemorrhage into a previously undiagnosed meningioma, leading to a subdural haematoma.

Section snippets

Case report

A 36 year-old female presented with a severe occipital headache of acute onset. Nine days prior, the patient had delivered her first child by Caesarean section, performed under spinal anaesthesia. She denied any recent head injury, and was breast-feeding at the time of presentation. Neurological examination was normal. CT of the brain (Fig. 1) revealed a 3 mm subdural haematoma overlying a large portion of the left cerebral hemisphere. Abutting the sphenoid ridge, there was also a 23 mm mildly

Discussion

Post-partum intra-tumoural haemorrhage within a meningioma has rarely been described [3], [4], but to our knowledge, this is the first described case with extra-tumoural extension of haemorrhage. While we do not have histopathological confirmation of the diagnosis of meningioma, the classic imaging features and subsequent stability are consistent with the diagnosis. Spontaneous haemorrhage is a rare complication of meningioma, occurring in only about 1.3–2.4% of cases [5]. Haemorrhage can be

Conclusion

Spontaneous haemorrhage from a meningioma is rare. Pregnancy and the post-partum setting may be a risk factor related to hormonal and haemodynamic changes.

Conflicts of interest/disclosures

Nil.

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