Acute haemorrhagic presentation of an intracranial meningioma

Acute haemorrhagic presentation of a meningioma is an extremely rare event. In a review of the literature, 44 such cases were found and only eight of them presented with sudden onset of coma. The outcome in these eight cases was, with few exceptions, poor. We report the case of a 72-year-old woman w ho presented with sudden onset of coma due to a massive haemorrhage into a frontal meningioma, The diagnosis was suspected on the basis of a non-enhan ced computed tomographic (CT) scan and considering the clinical status of t he patient, emergency evacuation of the haematoma and complete macroscopic resection of the tumour was performed without further diagnostic procedures . The patient fully recovered. Clinical examination and contrast enhanced C T scan at 3 months follow-up were considered normal. The prognosis for haem orrhagic presenting meningiomas is poor especially for those presenting wit h acute onset of coma. The outcome seems to be improved with rapid decompre ssion and tumour removal. We would like to stress the need to keep the diag nostic procedures to a minimum once a haemorrhagic decompensating meningiom a is suspected despite the risks associated with an incomplete radiological work up before surgery. Complete or at least gross tumour removal at the t ime of emergency surgery seems to be associated with a better outcome and s hould be attempted in all patients, even those presenting with acute signs of herniation.