[Massive intratumoral haemorrhage as a clinical presentation of acoustic neuroma]

Abstract

Introduction: Acoustic neurinoma presenting as massive intratumoural hemorrhage is quite an uncommon entity, with less than 40 clinical reports in the literature. Secondary mass effect compressing the brain stem may be a life threatening condition.

Case report: A 38 years old male was admitted at our hospital with several cranial nerve palsies on the right side and decreased level of consciousness (GCS 5) of acute onset. On cranial computed tomography a great haematoma was found in the right cerebello pontine angle, appearing to be an intratumoural bleeding. Emergency surgery was performed with complete removal of the haematoma and of the tumour related to the VIII cranial nerve, which was diagnosed as hypervascularized schwannoma. Clinical outcome was good.

Conclusions: Intratumoural hemorrhage in acoustic neurinomas is rare, appearing mostly in those tumours measuring more than 3 cm and with increased vascularity. In general they manifest with subtle neurological deficits. Acute neurological deterioration with decrease in consciousness level although exceptional may be associated to great mortality rates. The treatment of choice is the complete removal of the haematoma and the tumour, in one surgery if possible. Prognosis is good in most cases, with morbidity consisting on cranial nerve palsies. Hypoglossal facial anastomosis may restore at least partial facial function. Neurophysiology tests give a clear measurement of cranial nerve lesions and their evolution with treatments.