Subdural and subarachnoid hemorrhages secondary to head injury due to seizure from a meningioma

Case contributed by Assoc Prof Craig Hacking

Presentation

GCS 8 post seizure

Patient Data

Age: 90 years
Gender: Male

There is a relatively large left frontoparietal scalp hematoma. No skull fracture. There is a 37 x 35 x 28 mm (SI x AP x LR) left middle cranial fossa extra-axial lesion which has a broad origin from the inner table of the squamous portion of the left temporal bone. The lesion is of similar density to the brain and displays moderate uniform contrast enhancement. The deep margin of the lesion has a curvilinear band of calcium. There is a relatively large halo of abnormal low density within the superficial and deep white matter adjacent to this lesion extending to the left parietal lobe with secondary mass effect with displacement of the midline in the supratentorial compartment to the right by 5 mm. There is however no evidence of a brain herniation or obstructive hydrocephalus.

There is a low volume, blood density right-sided extra-axial collection, a subdural and subarachnoid distribution.

Conclusion

  • Relatively large left parietal scalp hematoma with a 'contrecoup' low volume right subdural and subarachnoid hemorrhage. No significant mass effect associated with the hemorrhage.
  • A large left middle cranial fossa extradural lesion is most likely a meningioma. Relatively extensive associated ipsilateral cerebral edema with 5 mm midline shift to the right, though no brain herniation or obstructive hydrocephalus.

Case Discussion

The lesion was excised and histology confirmed a WHO grade 1 meningioma.

The SAH and SDH is quiet subtle and could be missed without appropriate windowing.

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