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 »  Introduction
 »  Case report
 »  Discussion
 »  References

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Year : 2001  |  Volume : 49  |  Issue : 2  |  Page : 204-6

Meningioma associated with contralateral chronic subdural haematoma : a short report.


Departments of Neurosurgery and Histopathology, S.M.S. Medical College, Jaipur, 302017, India.

Correspondence Address:
Departments of Neurosurgery and Histopathology, S.M.S. Medical College, Jaipur, 302017, India.

  »  Abstract

Two unusual cases of meningiomas associated with opposite chronic subdural haematoma are presented.

How to cite this article:
Sinha V D, Dharker S R. Meningioma associated with contralateral chronic subdural haematoma : a short report. Neurol India 2001;49:204


How to cite this URL:
Sinha V D, Dharker S R. Meningioma associated with contralateral chronic subdural haematoma : a short report. Neurol India [serial online] 2001 [cited 2021 Sep 25];49:204. Available from: https://www.neurologyindia.com/text.asp?2001/49/2/204/1260




   »   Introduction Top

Intratumoural haemorrhage in an intracranial tumours is well known. Usually, it is associated with choriocarcinorma, malignant melanoma, metastatic lesions and glioblastoma multiforme. Benign tumours such as meningiomas rarely present with intracranial haemorrhage. We are reporting two cases of meningioma, who presented with chronic subdural haematoma on the opposite side.


   »   Case report Top

Case I : A 68 year old male presented with history of headache, vomiting and irritability of seven days duration. There was no history of head injury, hypertension and bleeding disorder. On examination, patient was irritable and had slurred speech. Fundus examination showed bilateral papilloedema. There was no motor or sensory deficit. Haemogram, urinalysis and blood biochemistry were normal. Plain and contrast CT scan of head showed chronic subdural haematoma on left frontoparietal region with enhancing extra axial mass lesion in right frontotemporal region. There was midline shift from left to right with compression of left lateral ventricle. Frontal horn of right lateral ventricle was also compressed [Figure 1a]. Left frontal and parietal burr holes were made and liquified dark coloured haematoma was evacuated. At the same time, right fronto temporal cranitomy was performed and total excision of tumour was done. The tumour was grayish, well capsulated and was highly vascular and at places was adherent to dura. The midline meningeal artery was prominent, tortuous and supplying the tumour. Histopathology confirmed meningioma. Post operative period was uneventful. Repeated CT after seven days showed no
residual chronic subdural haematoma or tumour mass [Figure 1b].
Case II : A 70 year old female presented with history of headache and generalised seizures of six months duration. The frequency of seizures was increasing for the last six months. On examination, there was no neurological deficit. Haemogram urinalysis and blood biochemistry were normal. Plain and contrast CT scan of head showed chronic subdural haematoma in left frontoparietal region with compression and midline shift of left ventricle and uniformly enhancing mass in right occipital region, suggestive of convexity meningioma [Figure 1c]. Left frontal and parietal burr holes were made and liquified haematoma was evacuated. Tumour excision was done about a month later, as the patient's attendants were not willing for tumour surgery at the time of evacuation of haematoma. Histopathology examination of the tumour confirmed meningioma. Postoperative period was uneventful.

   »   Discussion Top

Intracranial haemorrhage due to intracranial tumour is not unusual. Meningiomas however, rarely present with intracranial haemorrhage.[1],[2],[3],[4],[5] Few case reports of meningiomas associated with intracranial haemorrhage such as subarachnoid haemorrhage, subdural haemotama or intracranial haematoma, on the same side to that of tumour are documented.[6],[7],[8] Subarachnoid haemorrhage is by far the commonest locations.[9] In both the cases under discussion, the associated subdural haematoma was on the opposite side to that of meningioma. Different factors have been attributed to the occurrence of intracranial haemorrhage from meningiomas. Haemorrhage in one of their five cases of meningiomas described by Goran et al[10] was due to rupture of abnormal angiomatous vessels occupying only a very small portion of the tumour. Modesti et al[3] showed unusual vascularity near the site of haemorrhage in meningiomas causing intratumoural and subdural haematoma. Walsh et al[6] speculated that the expansion of the mass in subdural space may result in stretching of the communicating veins, making them more susceptible to rupture from minor trauma or primary haemorrhage in meningioma extending in subdural space. Presence of local fibrinolysis in meningiomas and other brain tumours has been reported, as evidenced by a high content of plasminogen activator in meningiomas measured by Todd's method. A high concentration of plasmiongen activators has been found in meningiomas, medulloblastoma, and cerebellar sarcomas.[11] The coagulation problems noted during protracted intracranial surgery and haemorrhage occurring unexpectedly during and after surgery might be attributed to this increased fibrinolysis from a large amount of plasminogen activators and a consumptive coagulopathy induced during surgery. Tucker et al[12] showed that meningioma cells in culture produced plasminogen activators. Kazunari[11] studied plasma fibrinolytic activity in 13 patients of meningioma and found a conspicuously elevated fibrinogen degradation product during surgery in two patients and fibrinolytic abnormality in another patient. They suggested that it is highly probable that these three patients had circulatory plasminogen activators, which were released from endothelial cells in tumour stroma in meningioma cells themselves or in the adjacent meninges prior to surgery. Histochemical studies of normal human brain and brain tumours have shown that the fibrinolytic activity is localised to the meningiomas and meninges.[13]
In our cases meningiomas were associated with chronic subdural haematoma of contralateral hemisphere. The probable cause of this kind of association is thought provoking. It could be incidental, due to trivial trauma because of seizures or increase in meningeal plasminogen activity. The local plasminogen activity was not worked up in any of our cases. However, Fox[14] stated convincingly that meningioma being fairly common and usually benign growth is easily subjected to an association by chance with varied and numerous lesions in the brain and elsewhere.
Helle and Conley,[7] while reviewing the literature reported that majority of meningiomas located on convexity were associated with intracranial haemorrhage. Angioblastic meningioma are more susceptible to haemorrhage, while incidence of haematoma in transitional meningioma, syncytial, fibrous and malignant meningioma was 0.3%, 0.5%, 0.2% and 4% respectively.[7]

 

  »   References Top

1.Cushing H, Eisenhardt L : In : Meningioma - Their classification, regional behavior, life history and surgical end results. Charles C. Thomas (ed.) Spring field. 1938; 785.   Back to cited text no. 1    
2.Skultety FM : Meningioma simulating ruptured aneurysm case report. J Neurosurg 1968; 28 : 380-382.   Back to cited text no. 2    
3.Modesti LM, Binet EF, Collins GH : Meningioma causing spontaneous intracranial haematoma. J Neurosurg 1976; 45 : 437-441.   Back to cited text no. 3    
4.Nakao S, Sato S, Ban S et al : Massive intracerebral haemorrhage caused by angioblastic meningiomas. Surg Neurol 1977; 7 : 245-248.   Back to cited text no. 4    
5.Lazaro RP, Messer H, Brinker RA : lntracranial haemorrhage associated with meningioma. Neurosurgery1981; 8 : 96-101.   Back to cited text no. 5    
6.Walsh W, Winston R, Smith Thomas : Meningioma with subdural haematoma. Surg Neurol 1977; 8 : 293.   Back to cited text no. 6    
7.Helle TL, Conley FK : Haemorrhage associated with meningioma : A case report and review of literature. J Neurol Neurosurg Psychiatry 1980; 43 : 725-729.   Back to cited text no. 7    
8.Chang WH, Sharma BS, Kak VK et al : Haemorrhage within an intracranial meningioma associated with chronic subdural haematoma. Br J Clin Pract 1990; 44 : 697-699.   Back to cited text no. 8    
9.Hayashi T, Shojima K, Utsunomiya H et al : Subarachnoid haemorrhage after pre-op embolisation of a cystic meningioma. Surg Neurol 1987; 27 : 295-300.   Back to cited text no. 9    
10.Goran A, Climineuo VJ, Fisher RG : Haemorrhage into meningiomas. Arch Neurol 1965; 13 : 65-69.   Back to cited text no. 10    
11.Oka K, Tsuda H, Kamikaseda K et al : Meningiomas and haemorrhage diathesis. J Neurosurg1988; 69 : 356-360.   Back to cited text no. 11    
12.Tucker WS, Kirsch WM, Martinez HA : In vitro plasminogen activator activity in human brain tumours. Cancer Res 1978; 38 : 297-302.   Back to cited text no. 12    
13.Tovi D, Pandolfi M, Astedt B : Local haemostasis in brain tumours. Experimentia1975; 31 : 977-978.   Back to cited text no. 13    
14.Fox JL : Meningioma and associated lesion. In : Meningioma. Mefty O (ed.) Raven Press, New York. 1991; 129-136.   Back to cited text no. 14    

 

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