spontaneous_intracranial_hematoma_caused_by_neoplasm

J.Sales-Llopis

Neurosurgery Department, University General Hospital of Alicante, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Alicante, Spain

Highly-vascularized, primary malignant brain tumors (BTs), including glioblastoma, oligodendroglioma and metastatic BT, tend to bleed spontaneously and should always be included in the differential diagnosis of non traumatic intracerebral hemorrhage 1).

Clinical and autopsy studies have identified that brain tumors represent 0.9–11% of spontaneous ICH 2) 3) 4) 5) 6) 7) 8) 9) 10) 11).

Up to 10% of patients with BTs may experience a diagnostic delay if CT is the only imaging modality that is used 12).

Dual-energy CT may be useful in detecting underlying tumors in patients with an ICH of unknown origin, and is a useful tool in differentiating between tumor bleeding and pure ICH in patients with acute ICH of an unclear origin 13).

Using MRI with gadolinium early in the post-operative period is likely to lead to an earlier detection of the BT. A previous study showed that the use of MR angiography (MRA) aided the disclosure of the development of an intratumoral aneurysm on a dilated feeding artery, the rupture of which led to intratumoral bleeding 14).

The standard treatment of a BT manifesting as an ICH is the surgical removal of the hematoma and the tumor 15) 16).

However, the optimal timing of the therapeutic intervention is poorly defined, particularly when the neurological status of the patient is stable following admission and there is only a minimal or no mass effect on the CT scan 17)


1)
Meyer JR, Gorey MT. Differential diagnosis of nontraumatic intracranial hemorrhage. Neuroimaging Clin N Am. 1998;8:263–293.
2)
Cahill DW, Ducker TB. Spontaneous intracerebral hemorrhage. Clin Neurosurg. 1982;29:722–779.
3)
Jellinger K. Pathology of intracerebral hemorrhage. Zentralbl Neurochir. 1977;38:29–42.
4)
Kothbauer P, Jellinger K, Flament H. Primary brain tumour presenting as spontaneous intracerebral haemorrhage. Acta Neurochir (Wien) 1979;49:35–45.
5)
Licata C, Turazzi S. Bleeding cerebral neoplasms with symptomatic hematoma. J Neurosurg Sci. 2003;47:201–210.
6)
Locksley HB, Sahs AL, Sandler R. Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage. 3 Subarachnoid hemorrhage unrelated to intracranial aneurysm and A-V malformation A study of associated diseases and prognosis. J Neurosurg. 1966;24:1034–1056.
7)
McCormick WF, Rosenfield DB. Massive brain hemorrhage: a review of 144 cases and an examination of their causes. Stroke. 1973;4:946–954.
8)
Mutlu N, Berry RG, Alpers BJ. Massive cerebral hemorrhage: clinical and pathologic correlations. Arch Neurol. 1963;8:644–661.
9)
Russel DS. Spontaneous intracranial haemorrhage. Proc R Soc Med. 1954;47:689–693.
10) , 15)
Schrader B, Barth H, Lang EW, Buhl R, Hugo HH, Biederer J, Mehdorn HM. Spontaneous intracranial haematomas caused by neoplasms. Acta Neurochir (Wien) 2000;142:979–985.
11)
Wakai S, Yamakawa K, Manaka S, Takakura K. Spontaneous intracranial hemorrhage caused by brain tumor: its incidence and clinical significance. Neurosurgery. 1982;10:437–444.
12)
Bell D, Grant R, Collie D, Walker M, Whittle IR. How well do radiologists diagnose intracerebral tumour histology on CT? Findings from a prospective multicentre study. Br J Neurosurg. 2002;16:573–577.
13)
Kim SJ, Lim HK, Lee HY, Choi CG, Lee DH, Suh DC, Kim SM, Kim JK, Krauss B. Dual-energy CT in the evaluation of intracerebral hemorrhage of unknown origin: differentiation between tumor bleeding and pure hemorrhage. AJNR Am J Neuroradiol. 2012;33:865–872.
14)
Hashiguchi A, Morioka M, Ichimura H, Mimata C, Kuratsu J. Glioblastoma with an intratumoral feeding-artery aneurysm. Clin Neurol Neurosurg. 2007;109:302–304.
16)
Morgenstern LB, Frankowski RF. Brain tumor masquerading as stroke. J Neurooncol. 1999;44:47–52.
17)
Inamasu J, Nakamura Y, Saito R, Kuroshima Y, Mayanagi K, Ichikizaki K. Rebleeding from a primary brain tumor manifesting as intracerebral hemorrhage (CNN 04/077, revised version) Clin Neurol Neurosurg. 2005;108:105–108.
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