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Intracranial Malignant Glioma Presenting as Subarachnoid Hemorrhage

Published online by Cambridge University Press:  02 December 2014

Stephen Hentschel  and
Brian Toyota
Stephen Hentschel
Affiliation:
Department of Surgery, Division of Neurosurgery, Vancouver Hospital and Health Sciences Centre, University of British Columbia, Vancouver, BC Canada
Brian Toyota
Affiliation:
Department of Surgery, Division of Neurosurgery, Vancouver Hospital and Health Sciences Centre, University of British Columbia, Vancouver, BC Canada
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Abstract

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Objective:

Cerebral aneurysms are the predominant cause of spontaneous subarachnoid hemorrhage (SAH). However, if an aneurysmal cause has been excluded, there remains but a short list of other potential etiologies. Cerebral neoplasms are clearly on this list but are most commonly meningiomas or metastatic lesions. This article details a case of a neoplasm that presented exclusively with SAH.

Clinical Presentation:

A 40-year-old male presented with a SAH with normal cerebral angiography. The initial magnetic resonance image revealed a lesion in the right insula thought to be resolving hemorrhage. Subsequent images, however, revealed the mass to be enlarging.

Intervention:

Craniotomy and resection of the lesion established a diagnosis of a malignant oligodendroglioma.

Conclusion:

An affirmation is made that patients experiencing ’angiographically-negative’ SAH should undergo MRI, occasionally on a serial basis, to exclude other etiologies for hemorrhage, including neoplasia.

Résumé:

RÉSUMÉ: Objectif:

Les anévrismes cérébraux sont la cause première d’hémorragie sous-arachnoïdienne spontanée. Cependant, si une cause anévrismale a été exclue, un petit nombre d’autres étiologies potentielles doivent être considérées, dont les néoplasies cérébrales. Parmi celles-ci les plus fréquentes sont les méningiomes et les lésions métastatiques. Cet article présente un cas de néoplasie dont la présentation initiale était une hémorragie sous-arachnoïdienne sans autre manifestation clinique.

Présentation clinique:

Un homme âgé de 40 ans a présenté une hémorragie sousarachnoïdienne avec une angiographie normale. L’imagerie par résonance magnétique (IRM) a montré une lesion dans l’insula droite qu’on a pensé être une hémorragie en voie de résolution. Des images subséquentes ont cependant montré une augmentation de volume de la masse.

Intervention:

La résection de la lésion par crâniotomie a montré qu’il s’agissait d’un oligodendrogliome malin.

Conclusion:

Les patients qui présentent une hémorragie sousarachnoïdienne et dont l’angiographie est négative devraient subir une IRM sériée au besoin, pour exclure d’autres étiologies de l’hémorragie, dont une néoplasie.

Type
Case Report
Information
Canadian Journal of Neurological Sciences , Volume 30 , Issue 1 , February 2003 , pp. 63 - 66
Copyright
Copyright © The Canadian Journal of Neurological 2003

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