Intracranial meningiomas revealed by non-traumatic subdural haematomas: A series of four cases

Objective. A review of the literature shows 33 cases of ipsilateral subdura l haematomas (SDH) associated with meningiomas. We suggest that physiopatho logical mechanisms could be primary haemorrhages from abnormal vessels in t he tumours and the opening of the intratumoral haematomas into the subdural . space. Our working hypothesis relies on a series of 300 meningiomas opera ted upon in our department since 1990; of these, 4 were revealed by SDH. Clinical Presentation. The four patients surgically treated in our departme nt had developed a progressive impairment of consciousness. There was no hi story of trauma, blood dyscrasia or anticoagulant therapy. After diagnosis, the SDH was drained, and the meningeal tumour was totally resected once it had been discovered. In one case, the presence of a tumour was demonstrate d by magnetic resonance imaging (MRI) performed only after the evacuation o f a recurrent SDH. Intervention. In each case, an acute SDH showing signs of recent bleeding w as evacuated. The meningeal tumour discovered proved to be the source of th e haemorrhage because of the numerous fresh blood clots both around and ins ide it. Histology. In the four cases histology showed fresh intratumoral haemorrhag es (ITH), large blood vessels with thin endothelial linings and haemosideri n deposits. In this review, SDH is associated with other haemorrhage sites in 24 of 37 cases (33 + our 4 cases). ITH was present in 14 cases (40%). Conclusion. The treatment should consist of the extirpation of the meningio ma at the same time as the evacuation of the haematoma. If primary ITH from abnormal vessels is the source of SDH, complete meningioma resection shoul d prevent the recurrence of SDH. Sub-dural membranes and haematomas should therefore be inspected for their intrinsic pathology, especially when there is no history of trauma.