Meningioma associated with aneurysm and subarachnoid hemorrhage: case report and review of the literature

A patient presented with spontaneous subarachnoid hemorrhage after a prolonged episode of coughing. A preoperative computed tomographic (CT) scan confirmed subarachnoid hemorrhage, but demonstrated no other lesion. Arteriography revealed an ophthalmic artery aneurysm. Operation revealed the aneurysm to be intracavernous without sign of prior rupture; however, a small hemorrhagic meningioma was removed from the ipsilateral anterior clinoid process. In this case, coincidental meningioma and aneurysm presented as a subarachnoid hemorrhage secondary to tumor hemorrhage. The follow-up of cases of subarachnoid hemorrhage with negative arteriography with sequential CT scans is discussed.     

Werner's syndrome associated with meningioma: case report

We present two cases of Werner's syndrome associated with intracranial meningioma. Characteristic clinical features of Werner's syndrome include short stature with slender extremities, premature senility, juvenile cataract, skin changes, a tendency to diabetes mellitus and familial occurrence. A 44-year-old female, who had been treated for diabetes mellitus, was diagnosed as having Werner's syndrome because of various characteristic features. A falx meningioma was incidentally found on CT scan, and was surgically removed. Her diabetes mellitus improved. The second case was a 28-year-old male was diagnosed as having Werner's syndrome, diabetes mellitus, juvenile cataract, together with diabetes insipidus, and liver dysfunction. He developed severe headache, gait disturbance and then became unconscious with right hemiparesis. He was found to have a parasagittal meningioma by CT scan and angiography. After removal of the tumor, diabetes mellitus, diabetes insipidus and liver dysfunction improved. The reported incidence of neoplasms associated with Werner's syndrome is about 10%. The majority of associated tumors were mesenchymal in origin. Ten meningiomas, 1 neurinoma and 2 gliomas are reported as associated tumors in the central nervous system. Most of the associated meningiomas were asymptomatic and found incidentally at autopsies or CT scans. Diabetes mellitus associated with Werner's syndrome is generally mild with high immunoreactive insulin value and is controllable by diet therapy and oral antidiabetic drugs. Daily profile of blood sugar improved after the removal of tumor in our cases. In 50 gm glucose tolerance test, tendency of delayed appearance of peak value, which is common in Werner's syndrome, was not altered in our cases. Discussion is made as to the association of Werner's syndrome with meningioma and diabetes mellitus.     

Hypertensive putaminal hemorrhage with extensive subarachnoid hemorrhage presenting extravasation of contrast material during angiography: case report

The authors describe a case of hypertensive putaminal hemorrhage with extensive subarachnoid hemorrhage. On admission, the patient aged 71 presented right-sided motor weakness. CT scan on admission revealed left putaminal hemorrhage with extension into the ipsilateral thalamus and lateral ventricle as well as into the subarachnoid space of the suprasellar, ambient, interhemispheric and contralateral sylvian cisterns. To exclude vascular lesions, left carotid angiography was performed just after admission. The lateral view was unremarkable, but the anterior-posterior view demonstrated extravasation of contrast material from the left lateral lenticulostriate artery. The angiographic sylvian point was shifted to the lateral side. No abnormal vessels were revealed. CT scan after angiography showed exacerbation of both intracerebral and subarachnoid hemorrhages, but the consciousness level was unchanged. CT-guided stereotactic aspiration of the hematoma was performed 4 days after the onset, but failed to remove much hemtoma. The patient died of aspiration pneumonia 9 days after onset. The authors emphasize that extensive subarachnoid hemorrhage in cases with hypertensive putaminal hemorrhage may be an important finding which indicates high risk of rebleeding.     

Spinal granular cell tumor with subarachnoid hemorrhage: case report

A granular cell tumor in the spinal canal that presented with subarachnoid hemorrhage is reported. The tumor was totally excised. The pathogenic and clinical aspects are discussed.     

Cystic meningioma originating from cavernous sinus: a case report

A 72-year-old man presented with gait disturbance and right homonymous hemianopsia. Magnetic resonance (MR) imaging showed a solid mass around the left cavernous sinus with rostral development of a multi-lobulated cystic component. The tumor was totally removed including the cystic wall via the left transsylvian approach with orbito-zygomatic craniotomy. Most of the tumor was attached to the lateral wall of the left cavernous sinus. Histological examination showed a meningioma WHO grade I with meningothelial meningioma formed lobules with intranuclear inclusions. His neurological symptoms disappeared immediately after the operation. Postoperative MR imaging revealed total removal of the tumor including the large cystic component.     

A case of subarachnoid hemorrhage associated with spontaneous intracranial hypotension

Cerebrospinal fluid (CSF) leakage has recently been documented in most patients, as the main cause of spontaneous intracranial hypotension (SIH). No cases of SIH accompanying an episode of subarachnoid hemorrhage (SAH) has yet been reported and, to the best of our knowledge, this is the first report of a patient, who developed SAH during his clinical course of SIH. SAH was cured completely by surgical intervention. A 57-year-old man, with a history of a sustained postural headache, suffered the sudden onset of severe nuchal pain. SAH in the basal cistern, together with the finding of bilateral subdural fluid retention were verified by CT. Angiogram showed no vascular abnormalities of cerebral or cervical vessels. Gd-enhanced Magnetic Resonance Imaging (MRI) disclosed diffuse meningeal enhancement. RI cisternogram and CT-myelogram (CTM) suggested that the region of CSF leakage should be in the retrospinal area at the level of C1-2. Because orthostatic headache failed to resolve even with 3 weeks of bed rest, surgical intervention was successfully carried out to seal the site of CSF leakage with the use of a fascia and fibrin glue. We have speculated that the etiology of SAH might have been a secondary rupture of congestive intracranial veins, such as basilar plexus or bridging veins, induced by a decrease of intracranial CSF pressure.     

A meningioma associated with AVM: a case report

This paper reports a case of meningioma associated with AVM. A 67 years old lady showed transient rt. lower hemiparesis with severe headache, nausea and consciousness disorder. Bilateral carotid angiogram and CT scan revealed lt. convexity meningioma and AVM. Lt MCA and ACA entered into the AVM from which several draining vessels entered into the deep venous system. These two lesions were removed by one stage. It is quite rare that cerebral tumor associates with intracranial AVM. Only two cases of meningioma associated with AVM have been reported.     

Spinal subarachnoid hemorrhage during myelography. Case report

Neoplasms of the conus medullaris and cauda equina have been shown to cause subarachnoid hemorrhage (SAH). In such instances, the hemorrhage has been the presenting symptom. A patient with a neurofibrom at T12-L1 experienced spinal SAH during myelography for suspected lumbar disc disease. The roentgenograms showing the lesion itself first and the subarachnoid clot subsequently may be unique. The cause of hemorrhage in this patient may have been the shearing of bridging capsular veins because of diminished cerebrospinal fluid pressure below the almost obstructing lesion.     

Cauda equina melanoma presenting with subarachnoid hemorrhage. A case report

The case of a 57-year-old woman with a primary melanoma of the cauda equina is reported. The peculiarity of the case is the very rare clinical presentation mimicking a subarachnoid hemorrhage. The patient underwent surgical excision of the mass. The clinicopathological and neuroradiological features are summarized.     

Pituitary adenoma associated with intraventricular meningioma: case report.

Although rare, the association of intracranial meningiomas and pituitary adenomas has been reported. Intraventricular meningiomas are unusual, and meningiomas located in the fourth ventricle are even more so. We report a patient who harbored a prolactin-secreting pituitary adenoma and a fourth ventricle meningioma who was treated with surgical resection of the latter and medical treatment for the former. To our knowledge, this is the first report of such an unusual association.     

Osteoid oteoma associated with intraosseous meningioma. A case report

A very rare case of intraosseous meningioma accompanied with osteoma is reported. A 57-year-old male was admitted with left chronic subdural hematoma and an operation was immediately performed. At the time of admission skull X-ray film showed a high density area in the right frontoparietal region. Postoperative CT scanning showed no abnormality at standard window, widths and levels or at higher window, widths and levels. 99m Tc MPP scinti gram showed increased activity in the right frontoparietal region. Tomography of the skull indicated hyperostosis involving all layers. This skull tumor was diagnosed as osteoma. At the second operation the osteoma was removed. There seemed to be no changes in the bone and underlying dura. Histological examination indicated multiple microscopic meningotheliomatous meningioma with psammoma bodies in Haversian canals, leading to the conclusion that this was osteoid osteoma. It is suggested that this case be designated as type Lopez II and that it raises some interesting points regarding histogenesis and development of meningioma.     

Cystic falx meningioma: report of a case with difficulty in radiologic diagnosis]

A case of cystic falx meningioma in the frontal region in which preoperative neuroradiologic diagnosis was difficult is reported. This 33-year-old man had suffered from epileptic seizures three times in one month. Physical and neurological examinations on admission were normal. A cystic mass with a small nodule was found on CT in the frontal region. Thin wall was enhanced smoothly and the nodule attached to the falx was enhanced heterogeneously. The mass was considered to be an extra-axial lesion on MRI. The right anterior falcine artery seemed to feed the mass. Bifrontal craniotomy was performed. Cyst was evacuated, and a soft reddish mass was subtotally removed. Cyst fluid was yellowish and protein content was 3.5 g/dl. Histopathological diagnosis was a meningotheliomatous meningioma and tumor cells were present also in the thin cyst wall. At the second operation the mass was completely removed, cyst wall inclusive. When we encounter a cystic mass in the sites of predilection of meningiomas, we have to consider the possibility of a cystic meningioma. If the mass has meningeal vascularization, a correct diagnosis is not difficult. Taking the location of the mass into consideration, an accurate interpretation of CT and MRI findings indicating extra-axial nature of the mass is indispensable.     

Arachnoid cyst with associated arachnoiditis developing after subarachnoid hemorrhage. Case report

The authors report the case of a 53-year-old woman in whom a T1-T2 spinal arachnoid cyst with associated arachnoiditis developed, compressing the thoracic spinal cord 1 year after the patient had suffered a Hunt and Hess Grade IV subarachnoid hemorrhage (SAH). Development of spinal arachnoiditis with or without an arachnoid cyst is a rare complication of aneurysmal SAH. Risk factors may include posterior circulation aneurysms, the extent and severity of the hemorrhage, and the need for cerebrospinal fluid diversion. Surgical drainage, shunt placement, or cyst excision, when possible, is the mainstay of treatment.     

Ampulla cardiomyopathy associated with aneurysmal subarachnoid hemorrhage: report of 6 patients

BACKGROUND: The authors report 6 cases of aneurysmal SAH associated with ampulla cardiomyopathy, which has been considered a unique type of stunned myocaridum. CASE DESCRIPTION: All patients were female, ranged from 35 to 79 years, and their echocardiograms revealed typical cardiac wall motions: the hypokinesia in the apical area of the left ventricle associated with the hyperkinesia in the basal area. In all, the cardiac function started to recover in the first few days; however, associated pulmonary congestions delayed aneurysmal surgeries in 3 patients. Among 3 patients whose surgeries were delayed, one died due to rerupture of aneurysm and another due to severe pneumonia. The other 4 patients recovered well, although one had left ventricular mural thrombus, which was treated successively with anticoagulant. CONCLUSIONS: It is considered highly important for neurosurgeons to be familiar with this clinical entity, since this transient cardiac function disturbance can be diagnosed at the initial presentation with a unique wall motion. The significance and clinical features of ampulla cardiomyopathy are discussed.     

Cystic meningioma. Case report and literature review

BACKGROUND: Cystic meningioma is a rare variety of meningioma. It represents 1,6 to 10% of intracranial meningiomas, the authors report a case of intracranial cystic meningioma with a review of literature. CASE REPORT: A 46-year-old female presented with left parietooccipital headache followed by right side hemiparesis. CT scan brain showed a left parietal tumor with double solid and cystic components thought to be glioma or metastasis preoperatively. At surgery the extraaxial solid and cystic lesion had a well defined capsule that could be easily separated from the perilesional cortical surface. The tumor was totally removed. The histological study showed a cystic meningioma. CONCLUSION: Cystic meningioma is an uncommon tumor that should be considered in the differential diagnosis of brain tumors with a cystic component.     

Carotid rete mirabile associated with subarachnoid hemorrhage

A 47-year-old man presented with carotid rete mirabile manifesting as subarachnoid hemorrhage (SAH). Computed tomography showed SAH, and angiography disclosed an abnormal vascular network around the petrous and cavernous portions of the internal carotid artery. Single photon emission computed tomography (SPECT) with technetium-99m methyl cysteinate dimer revealed reduced regional cerebral blood flow (CBF). Twelve months later, he was leading a normal life without neurological problems, hemorrhage, or ischemic manifestations. SPECT with iodine-123 N-isopropyl-p-iodoamphetamine and the acetazolamide challenge test showed the CBF had normalized.     

Spontaneous peritumoral haemorrhage associated with sinus confluence meningioma: case report

BACKGROUND: Torcular or sinus confluence meningioma is rare and surgically formidable. This reported sinus confluence meningioma was associated with peritumoral intracerebral hemorrhage. The surgical strategy and the mechanism of peritumoral hemorrhage are discussed. CASE DESCRIPTION: A 42-year-old woman presented with a history of headache, vomiting, and cerebellar dysfunction for 2 months. Plain computed tomography (CT) scan and magnetic resonance imaging (MRI) demonstrated a high-density mass in the torcular region involving both lateral sinuses. MR angiography demonstrated complete occlusion of the left lateral sinus and straight sinus and stenosis of the right lateral sinus. Two years after her first operation she experienced sudden headache and left upper quadrant hemianopsia. Plain CT scan and MRI showed a hyperintense tumor in the torcular region with an intracerebral hematoma in the right occipital lobe. An angiogram demonstrated occlusion of the caudal part of the superior sagittal sinus, bilateral transverse sinuses, and straight sinus.Gross total removal of the tumor was done along with the left lateral sinus through a suboccipital and a supratentorial occipital craniotomy in the first operation. The patient underwent total resection of the tumor at second operation through a bilateral occipital and suboccipital craniotomy along with resection of the dura including the confluence, the caudal part of the superior sagittal sinus, the right lateral sinus, and the straight sinus. The postoperative course was uneventful and postoperative MRI showed total removal of the tumor. CONCLUSION: Sinus confluence meningioma may present with peritumoral hemorrhage. Radical removal may be possible when the sinus confluence is completely occluded and there is good collateral drainage.