Hemorrhagic Stroke May Be the Sequelae of Brain Tumors

  • Adnan Khaliq Saidu Medical College/Saidu Teaching Hospital, Swat, Pakistan
  • Mumtaz Ali Prime Teaching Hospital/Peshawar Medical College,
  • Farooq Azam Lady Reading Hospital, Peshawar, Pakistan
  • Akram ullah Prime Teaching Hospital/Peshawar Medical College
  • Hamayun Tahir Qazi Hussain Ahmad Hospital, Nowshera
  • Nayab Gul Rehman Medical Institution Hayatabad, Peshawar
Keywords: Brain Tumors, Haemorrhagic stroke, Metastatic brain tumors, Astrocytoma, Oligodendroglioma

Abstract

Objective:  Hemorrhagic stroke is a common neurosurgical emergency caused by multiple pathological conditions. Brain tumors can also present with acute neurodeficits secondary to hemorrhagic stroke. This study as case series was conducted to report the clinical presentation, radiological findings, causes and management of brain tumors presenting as hemorrhagic stroke.

Materials and Methods:  Clinical assessment and radiological investigations were done, including CT brain and MRI brain with contrast. Surgery was done with evacuation of the hematoma and excision of tumor, and the tissue was sent for histopathology. Post operatively patients were shifted to the intensive care unit for monitoring and ventilator support if needed. Adjuvant treatment was guided according to histopathology report.

Results:  Total number of patients who were diagnosed to have a bleed in brain tumor were thirteen (n = 13). There were 6 (46%) males and 7 (54%) females. Mean age was 55 years. Among 13 patients, 4 (31%) patients had metastatic brain tumors and 9 (69%) patients had primary brain tumors. Diagnosis was done on CT brain, MRI brain and confirmed on histopathology of tissue obtained during surgery. Out of 13 patients, 5 (38%) patients were asymptomatic prior to hemorrhage and 8 (62%) patients had neurodeficits before and recent episodes of bleeding, which caused deterioration of neurological state.

Conclusion:  Malignant primary and metastatic brain tumors can present as acute focal deficits due to brain hemorrhage. Diagnosis is based on clinical presentation, radiological features and histopathology. 

References

1. Graus F, Rogers LR, Posner JB. Cerebrovascular
complications in patients with cancer. Medicine, 2016; 64: 16–35.
2. Jellinger K. Pathology of intracerebral hemorrhage. Zentral J Neurosurgery, 2015; 38: 29–42.
3. Yamauchi K, Umeda Y. Symptomatic intracranial haemorrhage in melaonma: analysis of CT and autopsy findings. JNS. 2018; 244: 94–100.
4. Padt JP, De Reuck J, Eecken HV. Intracerebral hemorrhage as initial symptom of a brain tumor. JNS. 2017; 73: 241–251.
5. Gildersleeve N, Koo AH, McDonald CJ. Metastatic tumor presenting as intracerebral hemorrhage. J Radiology, 2019; 124: 109–112.
6. DiMaio SM, DiMaio VJ, Kirkpatrick JB. Sudden, unexpected deaths due to primary intracranial neoplasms. J Forensic Med Pathol. 2015; 1: 29–45.
7. Schrader B, Barth H, Lang EW, et al. Spontaneous intracranial haematomas caused by neoplasms. Acta Neurochir, 2016; 142: 979–985.
8. Benveniste RJ, Manzano G, Petito CK. Multifocal glioblastoma multiforme with synchronous spontaneous hemorrhage: case report. J Neurooncol. 2014; 89: 55–58.
9. Kim IY, Jung S, Jung TY, Kang SS, Choi C. Primary central nervous system lymphoma presenting as an acute massive intracerebral hemorrhage: case report with immune histo chemical study. Surg Neurol. 2013; 70: 308–311.
10. McIver JI, Scheithauer BW, Rydberg CH, Atkinson JL. Metastatic breast carcinoma presenting as Brain hemorrhage: case report. JNS. 2015; 49: 447–449.
11. Wakai S, Yamakawa K, Manaka S, Takakura K. Spontaneous intracranial hemorrhage caused by brain tumor: its incidence and clinical significance. JNS. 2017; 77: 54-60. 10: 437–444.
12. Kondziolka D, Bernstein M, Resch L, et al. Significance of hemorrhage into brain tumors: clinicopathological study. J Neurosurg. 2016; 67: 852–857.
13. Yuguang L, Meng L, Shugan Z, et al. Intracranial tumoural haemorrhage: a report of 58 cases. J Clin Neurosci. 2002; 9: 637–639.
14. Bitoh S, Hasegawa H, Ohtsuki H, Obashi J, Fujiwara M, Sakurai M. Cerebral neoplasms initially presenting with massive intracerebral hemorrhage. Surg Neurol. 2016; 22: 57–62.
15. Kase CS. Intracerebral hemorrhage: non-hypertensive causes. Surg Neurol Stroke, 2011; 17:
590–595.
16. Russel DS. Spontaneous intracranial haemorrhage. Surg Neurol. 2018; 47: 689–693.
17. Mutlu N, Berry RG, Alpers BJ. Massive cerebral hemorrhage: clinical and pathologic correlations. Arch Neurol. 2009; 8: 644–661.
18. Locksley HB, Sahs AL, Sandler R. Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage, 3: Subarachnoid hemorrhage unrelated to intracranial aneurysm and A-V malformation—a study of associated diseases and prognosis. J Neurosurg, 2018; 24: 1034–1056.
19. Kothbauer P, Jellinger K, Flament H. Primary brain tumour presenting as spontaneous intracerebral haemorrhage. Acta Neurochir. 1979; 49: 35–45.
20. Cahill DW, Ducker TB. Spontaneous intracerebral hemorrhage. Clin Neurosurg, 1982; 29: 722–779.
21. Licata C, Turazzi S. Bleeding cerebral neoplasms with symptomatic hematoma. J Neurosurg Sci. 2013; 47: 201–210.
22. McCormick WF, Rosenfield DB. Massive brain hemorrhage: a review of 144 cases and an examination of their causes. Stroke, 2016; 4: 946–954.
23. Lieu AS, Hwang SL, Howng SL, Chai CY. Brain tumors with hemorrhage. J Formos Med Assoc. 1999; 98: 365–367.
24. Kyrnetskiy EE, Kun LE, Boop FA, Sanford RA, Khan RB. Types, causes, and outcome of intracranial hemorrhage in children with cancer. J Neurosurg. 2015; 102: 31–35.
25. Oldberg E. Hemorrhage into gliomas: a review of eight hundred and thirty-two consecutive verified cases of glioma. Arch Neurol Psychiatry, 2017; 30: 1061–1073.
26. Drake CG, McGee D. Apoplexy associated with brain tumours. Can Med Assoc J. 2018; 84: 303–305.
27. Scott M. Spontaneous intracerebral hematoma caused by cerebral neoplasms: report of eight verified cases. J Neurosurg. 2019; 42: 338–342.
28. Mandybur TI. Intracranial hemorrhage caused by metastatic tumors. Surg Neurology, 1977; 27 (7): 650–655.
29. Liwnicz BH, Wu SZ, Tew JM. The relationship between the capillary structure and hemorrhage in gliomas. J Neurosurg. 2018; 66: 536–541.
Published
2021-01-01
Section
Original Article