CASE REPORT
Introdução: Meningiomas são os tumores intracranianos benignos mais comuns e geralmente se manifestam com sintomas de uma massa neoplásica de crescimento lento. A apresentação aguda com hemorragia intracraniana é extremamente rara. Relato do Caso: Paciente masculino de 54 anos foi admitido no pronto-socorro por quadro súbito de cefaleia intensa, evoluindo rapidamente para piora do estado de consciência e hemiplegia esquerda. A tomografia computadorizada de crânio revelou grande massa frontal direita associada a hemorragia volumosa perilesional, compressão das cisternas basais e desvio das estruturas da linha média. A ressonância magnética confirmou os achados e mostrou tratar-se de provável meningioma com hemorragia perilesional. O paciente foi levado à sala de cirurgia e submetido a uma grande craniotomia frontal direita, o meningioma e a lesão hemorrágica adjacente foram completamente removidos. Após dois meses de tratamento cirúrgico, permanece com déficit motor parcial esquerdo. A análise anatomopatológica revelou que a lesão neoplásica era um meningioma atípico (OMS Grau II). Conclusão: A hemorragia parenquimatosa do meningioma convexo é uma condição complexa que deve ser tratada com urgência. A suspeita precoce, o diagnóstico correto e o tratamento urgente da doença em conjunto parecem desempenhar um papel fundamental na redução da mortalidade e morbidade.
Introduction: Meningiomas are the most common benign intracranial tumor and usually are manifested with symptoms from a slow growing neoplastic mass. Acute presentation with intracranial hemorrhage is extremely rare. Case Presentation: A 54 years-old man was admitted at the emergency department presenting sudden onset of severe headache, evolving rapidly to deterioration of consciousness and left hemiplegia. Cranial computed tomography scan revealed a large right frontal mass associated with perilesional volumous hemorrhage, and compression of basal cisterns and deviation of midline structures. Brain magnetic resonance confirmed the previous findings and also showed that the neoplastic lesion was a probable meningioma with a frontal convexity of dural tail and relevant adjacent brain edema. The patient was taken to the operating room and the meningioma and the adjacent hemorrhagic lesion were completely removed through a large right frontal craniotomy. After two months of surgical treatment, he remains with left side partial motor deficit. Anatomopathological analysis revealed that the neoplastic lesion was an atypical meningioma (WHO Grade II). Conclusion: Parenchymal hemorrhage from convexity meningioma is a complex condition that must be treated urgently. Early suspicion, correct diagnosis and urgent treatment of the condition all together seems to play a key role reducing mortality and morbidity.
1. Ostrom QT, Gittleman H, Xu J, et al. CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2009-2013. Neuro-oncol. 2016;18(Suppl 5):v1-75. http://dx.doi.org/10.1093/neuonc/now207. PMid:28475809.
2. Chamberlain MC, Blumenthal DT. Intracranial meningiomas: diagnosis and treatment. Expert Rev Neurother. 2004;4(4):641-8. http:// dx.doi.org/10.1586/14737175.4.4.641. PMid:15853583.
3. Ogasawara C, Philbrick BD, Adamson DC. Meningioma: a review of epidemiology, pathology, diagnosis, treatment, and future directions. Biomedicines. 2021;9(3):319. http://dx.doi.org/10.3390/ biomedicines9030319. PMid:33801089.
4. Pressman E, Penn D, Patel NJ. Intracranial hemorrhage from meningioma: 2 novel risk factors. World Neurosurg. 2020;135:217-21. http://dx.doi.org/10.1016/j.wneu.2019.10.173. PMid:31698125.
5. Cheng MH, Lin JW. Intracranial meningioma with intratumoral hemorrhage. J Formos Med Assoc. 1997;96(2):116-20. PMid:9071837.
6. Sumi K, Suma T, Yoshida R, et al. Massive intracranial hemorrhage caused by intraventricular meningioma: case report. BMC Neurol. 2021;21(1):25. http://dx.doi.org/10.1186/s12883-021-02056-4. PMid:33451289.
7. Lieu AS, Howng SL. Intracranial meningioma with hemorrhage. Kaohsiung J Med Sci. 1999;15(2):69-74. PMid:10089715.
8. Lazaro RP, Messer HD, Brinker RA. Intracranial hemorrhage associated with meningioma. Neurosurgery. 1981;8(1):96-101. http:// dx.doi.org/10.1227/00006123-198101000-00018. PMid:7010202.
9. Entezami P, Riccio A, Kenning TJ. Intratumoral hemorrhage within petrous meningioma. World Neurosurg. 2018;117:246-8. http://dx.doi. org/10.1016/j.wneu.2018.06.100. PMid:29936208.
10. Boŝnjak R, Derham C, Popović M, Ravnik J. Spontaneous intracranial meningioma bleeding: clinicopathological features and outcome. J Neurosurg. 2005;103(3):473-84. http://dx.doi.org/10.3171/ jns.2005.103.3.0473. PMid:16235680.
11. Hatch EE, Linet MS, Zhang J, et al. Reproductive and hormonal factors and risk of brain tumors in adult females. Int J Cancer. 2005;114(5):797- 805. http://dx.doi.org/10.1002/ijc.20776. PMid:15609304.
12. Kuan AS, Chen YT, Teng CJ, Wang SJ, Chen MT. Risk of meningioma in patients with head injury: a nationwide population-based study. J Chin Med Assoc. 2014;77(9):457-62. http://dx.doi.org/10.1016/j. jcma.2014.06.005. PMid:25088906.
13. Fan Z, Ji T, Wan S, et al. Smoking and risk of meningioma: a meta-analysis. Cancer Epidemiol. 2013;37(1):39-45. http://dx.doi. org/10.1016/j.canep.2012.09.004. PMid:23102704.
14. Chen F, Wang P, Lan J, et al. Wireless phone use and adult meningioma risk: a systematic review and meta-analysis. Br J Neurosurg. 2021;35(4):444-50. http://dx.doi.org/10.1080/02688697.2020.185678 4. PMid:33305648.
15. Wiemels J, Wrensch M, Claus EB. Epidemiology and etiology of meningioma. J Neurooncol. 2010;99(3):307-14. http://dx.doi. org/10.1007/s11060-010-0386-3. PMid:20821343.
16. Marosi C, Hassler M, Roessler K, et al. Meningioma. Crit Rev Oncol Hematol. 2008;67(2):153-71. http://dx.doi.org/10.1016/j. critrevonc.2008.01.010. PMid:18342535.
17. Gyawali S, Sharma P, Mahapatra A. Meningioma and psychiatric symptoms: an individual patient data analysis. Asian J Psychiatr. 2019;42:94- 103. http://dx.doi.org/10.1016/j.ajp.2019.03.029. PMid:30999261.
18. Moore E, Srivastava AA, Rajaram Manoharan SVR, Hussain N. Mania and psychosis associated with right parietal meningioma. Int J Psychiatry Med. 2020;55(2):74-81. http://dx.doi.org/10.1177/0091217419885218. PMid:31698993.
19. Williams T, Brechin D, Muncer S, Mukerji N, Evans S, Anderson N. Meningioma and mood: exploring the potential for meningioma to affect psychological distress before and after surgical removal. Br J Neurosurg. 2019;33(4):383-7. http://dx.doi.org/10.1080/02688697.20 19.1571163. PMid:30829086.
20. Zivković N, Marković M, Spaić M. Convexity meningioma associated with depression: a case report. Srp Arh Celok Lek. 2014;142(9-10):586- 8. http://dx.doi.org/10.2298/SARH1410586Z. PMid:25518538.
21. Fountain DM, Soon WC, Matys T, Guilfoyle MR, Kirollos R, Santarius T. Volumetric growth rates of meningioma and its correlation with histological diagnosis and clinical outcome: a systematic review. Acta Neurochir. 2017;159(3):435-45. http://dx.doi.org/10.1007/s00701-016- 3071-2. PMid:28101641.
22. Ehresman JS, Mampre D, Rogers D, Olivi A, Quinones-Hinojosa A, Chaichana KL. Volumetric tumor growth rates of meningiomas involving the intracranial venous sinuses. Acta Neurochir. 2018;160(8):1531-8. http://dx.doi.org/10.1007/s00701-018-3571-3. PMid:29869111.
23. Yao X, Wei T, Zhang H, Li J, Tang A, Ren K. The natural growth rate of skull base meningiomas compared with non-skull base meningiomas. J Craniofac Surg. 2019;30(4):1231-3. http://dx.doi.org/10.1097/ SCS.0000000000005468. PMid:30908440.
24. Buerki RA, Horbinski CM, Kruser T, Horowitz PM, James CD, Lukas RV. An overview of meningiomas. Future Oncol. 2018;14(21):2161-77. http://dx.doi.org/10.2217/fon-2018-0006. PMid:30084265.
25. Licata B, Turazzi S. Bleeding cerebral neoplasms with symptomatic hematoma. J Neurosurg Sci. 2003;47(4):201-10, discussion 210. PMid:14978474.
26. Bhatoe HS, Singh P, Dutta V. Intraventricular meningiomas: a clinicopathological study and review. Neurosurg Focus. 2006;20(3):E9. http://dx.doi.org/10.3171/foc.2006.20.3.10. PMid:16599425.
1 MD, Service of Neurosurgery, Fundação Faculdade Regional de Medicina de São José do Rio Preto – FUNFARME, Hospital de Base, São José do Rio Preto, SP, Brazil.
Received Jun 10, 2021
Accepted Feb 6, 2023
