Intracranial malignant glioma presenting as subarachnoid hemorrhage.

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.