Meningioma Presenting As Hemorrhagic Stroke: A Case Report And Review Of Literature.

Abstract

Introduction: Meningiomas are the most common intracranial brain tumors, with an incidence of 8 cases per 100000 in a year. Meningiomas commonly present with various symptoms depending on the affected site, including upper motor neuron signs, anosmias, headache, visual impairment, behavioral changes, and cranial nerve palsy, but they rarely present with hemorrhagic stroke. We present a case report of a patient whose initial presentation was a hemorrhagic stroke. Case report: A 51-year-old male diabetic on medication and not a known hypertensive presented with a 13-hour history of reduced consciousness. On examination, the patient had a Glasgow Coma Scale score of 11 (Eye 4, Motor 5 (hemiplegia) Verbal 2). An urgent CT scan showed a left basal ganglia hemorrhage with intraventricular extensions and a parafalcine tumor. MRI showed a parafalcine tumor with characteristics of a meningioma and a mass effect. He was taken to the OR and underwent tumor excision and hematoma evacuation. Intraoperatively a falx meningioma, not extending to the superior sagittal sinus, was found with a large intracerebral hemorrhage surrounding the meningioma. A Simpsons grade 2 excisions of the tumor and evacuation of the hematoma were done. The patient has completed post-op radiotherapy and is currently ambulant on crutches with normal speech. Conclusion/LESSONS LEARNT: Hemorrhage is a rare presentation of a meningioma, but that does not reduce the need for careful assessment of scans from patients presenting with spontaneous intracerebral hemorrhage. Early surgery and gross total tumor resection of the tumor, if possible with hematoma evacuation, are therapy goals.