Meningioma Associated with Subdural Hematoma

Intracranial hemorrhages associated with meningiomas are extremely rare. A 36-year-old man was admitted with complaints of a dull headache, nausea, vomiting and a slight disorientation which persisted for a few weeks. CT showed a right subdural hematoma or effusion and high density areas in the right middle fossa and in the Sylvian fissure respectively. Right carotid angiography showed a very large avascular zone. On trepanation, a large subdural hematoma surrounded by typical outer and inner membranes was encountered and about 150 ml of dark brownish fluid was removed. A few days after the operation the same complaints as mentioned above reappeared and trepanation was repeated. Right fronto-temporal craniotomy was performed 8 days after the 2nd operation. During the operation a large subdural hematoma surrounded by firm capsules was found in the right fronto-parieto-temporal region. Part of a tumor originating from the right lateral third of the sphenoidal ridge protruded through the inner membrane into the hematoma cavity. A few small tumors were also found within the hematoma cavity. Most of the hematoma capsules and the tumor masses were removed and also another tumor mass growing in the Sylvian fissure was partially resected. Histological examinations showed the tumor to be a meningotheliomatous meningioma with sarcomatous changes. The patient died less than one month after the last operation. Postmortem examination disclosed numerous metastatic tumor masses throughout the central nervous system. Including the present case, a total of 15 reported cases of meningiomas associated with intracranial hematomas were reviewed and discussed.