Spontaneous Hemorrhage followed by paraparesis in a patient with a Spinal Meningioma

BACKGROUND Although rare, spinal meningiomas may cause motor and sensory deficits or difficulty with bladder or bowel function due to spinal cord compression. While hemorrhage of intracranial meningiomas is well documented, there are very few cases of hemorrhage or hematoma associated with spinal meningiomas in the literature. Spinal meningiomas have been reported to be associated with subdural, epidural, intratumoral, and subarachnoid hemorrhage and usually in the setting of inciting event such as lumbar puncture or anti-coagulation therapy.
CASE DESCRIPTION A 68-year old women presented to the emergency room with acute onset of paraparesis in the lower extremities. MRI findings were inconclusive for cause but showed cord compression. Intra-operative findings demonstrated an intratumoral hemorrhage and pathology was consistent with meningioma.
CONCLUSIONS This is the first report found in the English literature of a patient who first develops symptoms from a spinal meningioma with spontaneous intratumoral hemorrhage presenting with acute paraparesis. MRI findings in retrospect match surgical intra-operative findings. Prompt surgical intervention can result in complete resolution of neurological deficits.

as reported in: World Neurosurg. 2019 Jan 23 [Epub ahead of print]