Falx Meningioma Presenting with Intratumoral Hemorrhage and Interhemispheric Acute Subdural Hematoma:A Case of Report Kei SATO 1,4 , Ayaka MATSUO 1 , Takeshi HIU 1 , Hirokazu KUROHAMA 3 , Shiro MIURA 2 , Kakehiro ITO 1 , Tomoya MORITSUKA 1 , Kazuya HONDA 1 , Ichiro KAWAHARA 1 , Tomonori ONO 1 , Wataru HARAGUCHI 1 , Ryujiro USHIJIMA 1 , Keisuke TSUTSUMI 1 1Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center 2Department of Pathology, National Hospital Organization Nagasaki Medical Center 3Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University 4Department of Neurosurgery, Nagasaki University Hospital Keyword: falx meningioma , interhemispheric acute subdural hematoma , intratumoral hemorrhage , vein of Galen stenosis , superior sagittal sinus stenosis pp.413-422
Published Date 2020/5/10
DOI https://doi.org/10.11477/mf.1436204203
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 A 68-year-old male with a sudden headache while defecation was transferred to our hospital. He was initially diagnosed with intracerebral hemorrhage in the right occipital lobe and acute subdural hematoma(ASDH)in the right interhemispheric fissure. A CT angiography(CTA)showed stenosis in the superior sagittal sinus(SSS)and the vein of Galen(VG)near the hematoma, which were considered to be due to compression of the hematoma. In the source image of CTA, the enhancement effect of the hematoma part was not clear. MRI revealed a heterogeneous mixed signal intensity in the hematoma area, suggesting a mixture of hematoma components that had bled at different times. Cerebral angiography performed two weeks after onset showed a tumor shadow imaged from the middle meningeal artery. Therefore, the presence of hemorrhagic meningioma was suspected. This was confirmed by contrast-enhanced MRI.

 One month after the onset, tumor resection was performed after the embolization of the feeding artery. Part of the tumor around the SSS and VG was left due to severe adhesion. Postoperatively, stenosis of the SSS and VG significantly improved. In this case, the increase in venous pressure may be related to the bleeding mechanism.

 Hemorrhagic onset meningioma with interhemispheric ASDH is extremely rare, and only 4 cases have been reported. It is easy to misdiagnose if only non-contrast CT is used. It should be noted that in cases of intratumoral hemorrhage, CTA may not show an enhancing effect in the acute phase. Since contrast-enhanced MRI may be useful for a definitive diagnosis, it should be performed at the time of initial imaging.

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