Acoustic neurinoma with massive hemorrhage within the tumor tissue. A case report

In some kinds of benign intracranial tumors, as meningioma, choroid plexus papilloma, pituitary adenoma or hemangioma, it has been reported that subarachnoid hemorrhage or massive hemorrhage within the tumor tissue occurred in some cases. However, literatures on massive hemorrhage from acoustic neurinoma seemed to be rare. Recently we have experienced a case of acoustic neurinoma with massive hemorrhage within the tumor tissue. The patient was a 71-yr-old woman who had suffered from left hearing disturbance for several years and gradually progressive mental deficits and was hospitalized on November 14, 1978. She was diagnosed as having left acoustic neurinoma based on the findings of several examinations. In the period of preparation for the operation, she suddenly developed left facial palsy and left taste disturbance. She complained of mild headache, but consciousness was not disturbed. Non-contrast CT scan revealed an irregular high density region in the left cerebellopontine angle and a high density region by contrast enhancement, which was larger than that on the previous examination. At the surgical operation, 5 ml, liquefied hematoma and about 20 gm coagulated blood were observed in the rostral and medial portion of the tumor. Histological examination verified acoustic neurinoma of Antoni A type containing massive clot as well as hemosiderin-laden cells. The patient expired 8 days after the operation without restoration of consciousness. It was emphasized in the present report that one must take into consideration that a massive hemorrhage from the tumor itself is occasionally one of the causes of aggressive deterioration of clinical symptoms in patients with acoustic neurinoma.