Incidental intraoperative finding of meningioma in spontaneous acute subdural hematoma: A case report from Saudi Arabia and review of literature()

INTRODUCTION: An association of meningioma with spontaneous acute subdural hematoma has been rarely reported in the literature. Up to date, 38 cases have been reported. PRESENTATION OF CASE: A 74-year-old Saudi female known case of hypertension presented suddenly with dizziness, headache, and left lower limb weakness for 6 h. No history of trauma or anticoagulant medication. Computed tomography scan showed acute subdural hematoma. Pre-operative images were negative for any vascular pathology or lesional tissue. The patient underwent surgery for evacuation of the subdural collection. The presence of abnormal soft tissues within the hematoma was discovered during the surgery and sent for analysis. Histopathological results showed meningothelial subtype grade I meningioma. The patient recovered well, with no obvious neurological deficit or immediate complication. DISCUSSION: Spontaneous acute subdural hematoma without a predisposing factor is a rare occurrence; consequently, a thorough investigation is mandatory in such case to reach the hidden aetiology. CONCLUSION: In this report a rare association of meningioma with an acute subdural hematoma described. Our case was the first one reported where meningioma incidentally discovered during procedure without preoperative suspicion. A small size intracranial lesion may not be detected by preoperative radiological assessment in the presence of a hematoma. Systematic inspection of the operative field is an important surgical step despite negative preoperative radiological images. Our case supports the mechanism of rupture of abnormal vascular structure. More cases needed to understand the mechanism of such a rare association.