Hemorrhagic presentation of previously silent brain tumors

Introduction and objectives

Acute presentation with intracranial hemorrhage owing to a previously silent brain tumor (BT) is rare. Although any BT can bleed, the frequency and type of bleeding varies across tumor types.

Materials and methods

We aimed to retrospectively review our experience with 55 patients with BTs presenting with ICH.

Results

Signs of increased intracranial pressure were the most common symptoms. The temporal lobe was the most common lesion site (n = 22). Hemorrhages were mainly confined to the tumor margins (HCTs) (n = 34). Extensive intraparenchymal hemorrhages (EIHs) were mainly associated with moderately/severely decreased levels of consciousness (LOCs) (n = 15/16). High-grade glioma (HGGT) (n = 25) was the leading pathological diagnosis followed by metastasis (MBT) (n = 16/55). The hemorrhage type was associated with the pathological diagnosis of the tumor. Patients with HGGT (n = 19/25) and MBT (n = 9/16) mainly presented with HCTs, whereas low-grade gliomas (LGGT) primarily caused EIHs (n = 6/7).

Conclusions

Hemorrhagic presentation is a rare occurrence in BTs. Among all, MBT and HGGT are responsible for majority of the cases. Importantly, despite their relatively benign characteristics, LGGTs mainly result in extensive parenchymal destruction once they bleed. Maximum surgical resection of hemorrhagic BTs and decompression of the affected brain regions followed by histological confirmation of the diagnosis should be the main goals of treatment in cases with hemorrhagic BTs.