Unit of Neuroimaging, Diagnostic and Functional Neuroradiology, Clinical Department of Neurological and Motor Sciences, Azienda Ospedaliero-Universitaria Senese, Santa Maria Alle Scotte National Health System and University Hospital, Tuscany, Siena, Italy.
Department of Radiology, Diagnostic and Interventional Neuroradiology, Kingston Health Science Centre, Queen's University, Kingston, ON, Canada.
Emerg Radiol. 2023 Apr;30(2):175-185. doi: 10.1007/s10140-023-02115-y. Epub 2023 Jan 28.
This study aims to increase awareness of the hemorrhagic presentation of intracranial meningiomas in the emergency department and present clues for neuroradiological diagnosis, which is crucial for pertinent management. We described the prevalence of hemorrhage in a large population of meningioma patients, with emphasis on clinical presentation, computed tomography (CT), magnetic resonance (MR), and digital subtraction angiography (DSA) findings.
This retrospective analysis has been performed at two reference institutions between January 2002 and December 2015, and includes 1304 patients with histologically proven newly diagnosed intracranial meningioma. Clinical features and neuroradiological findings of intracranial meningiomas presenting with hemorrhage have been reviewed.
Twenty-four patients (1.8%, 16 females, 8 males, age range: 29-88 years) were found to have spontaneous hemorrhagic onset of the newly diagnosed meningioma. A sudden onset occurred in 23/24 patients. Sixteen patients showed isolated intralesional hemorrhage, four had subdural hematomas, and the remaining four presented combined intralesional and subarachnoid (n = 2) or intraventricular (n = 2) hemorrhages. In 13 patients, CT showed both the hemorrhage and the meningioma. In the other 11 patients, diagnosis was achieved by emergency or early surgery (n = 5), MRI (n = 5), and DSA (n = 1).
The presence of an underlying meningioma has to be considered in the differential diagnosis of spontaneous intracranial hemorrhage, although this is a rare event. CT, MRI, and occasionally DSA were useful to obtain the diagnosis; however, in up to a fifth of patients, this was achieved at surgery.
本研究旨在提高对急诊科颅内脑膜瘤出血表现的认识，并提供神经影像学诊断线索，这对恰当的治疗至关重要。我们描述了大量脑膜瘤患者中出血的发生率，重点介绍了临床表现、计算机断层扫描（CT）、磁共振成像（MR）和数字减影血管造影（DSA）的发现。
本回顾性分析在 2002 年 1 月至 2015 年 12 月期间在两家参考机构进行，共纳入 1304 例经组织学证实的新发颅内脑膜瘤患者。回顾分析了颅内脑膜瘤自发性出血患者的临床特征和神经影像学表现。
发现 24 例（1.8%，16 例女性，8 例男性，年龄范围：29-88 岁）的新发脑膜瘤自发性出血。24 例患者中，23 例为突发起病。16 例患者表现为单纯瘤内出血，4 例为硬膜下血肿，4 例表现为瘤内和蛛网膜下腔（n=2）或脑室内（n=2）出血混合。13 例患者 CT 显示出血和脑膜瘤均存在。在另外 11 例患者中，通过急诊或早期手术（n=5）、MRI（n=5）和 DSA（n=1）诊断。
自发性颅内出血的鉴别诊断中应考虑到存在潜在脑膜瘤的可能，尽管这种情况较为少见。CT、MRI，偶尔 DSA 有助于获得诊断；然而，多达五分之一的患者需要在手术中获得诊断。
