Hemorrhagic low grade glioma

Intracerebral hematoma is an unusual clinical presentation for low grade gliomas and it has been described in a small number of cases in adults 1) 2) 3).

Hemorrhagic low grade glioma (LGG) without malignant transformation is rare, accounting for less than 1% of cases.

It is now generally accepted that the main cause of mortality in these tumors is their dedifferentiation to a higher degree of malignancy 4) 5) 6).

Case reports

Hemorrhagic LGG with an arteriovenous(AV)shunt has not been reported.

Matsuura et al., from the Toho University Medical Center Omori Hospital, report the case of a 17-year-old man with low grade glioma (LGG) with an arteriovenous fistula. He presented to the hospital with seizureComputed tomography(CT) demonstrated a hypodense lesion with mass effect in the right frontal lobeT1-weighted images(WI)and T2WI on magnetic resonance imaging(MRI) revealed acute-onset hemorrhage in the right frontal lobe. Furthermore, a ring enhancing lesion was noted on gadolinium (Gd)-DTPA T1WI, and an AV shunt was found in the same region on angiographyGross total tumor resection was performed. The pathological diagnosis was diffuse astrocytoma with pilomyxoid features (WHO grade II). Without adjuvant therapy, no residual tumor was found on MRI at the 6-year follow-up examination. They treated a case of hemorrhagic LGG with an AV shunt. Intratumoral hemorrhage in LGG may occur and should be considered for the differential diagnosis 7).

A 53-year old woman presenting to the hospital with a hemorrhagic low-grade glioma (LGG). She was admitted to a nearby general hospital where she had presented with aphasia, right hemiplegia and change of mental status. Computer tomography (CT) images showed a left temporo-parietal hemorrhage with mass effect. She was transferred to the neuro-intensive care unit where emergency craniotomy was performed. A tumor with hematoma was removed and further histopathology analysis revealed tumor progression. They reviewed the literature reporting cases of central nervous system tumors hemorrhage and found that these types of events are exquisitely rare in adults with LGG. However these events are possible, suggesting that it should be included in the differential diagnosis of any patient presenting with intracranial hemorrhage. This case raises questions regarding the benefit of early versus late intervention for patients known to have LGG 8).

Della Puppa et al., reviewed the literature of such cases and reported another case of a haemorrhagic low-grade glioma in a 54-year-old woman presenting with a left hemiparesis. Computer tomography (CT) images showed a right basal ganglia haemorrhage with no mass effect. Vascular malformations were ruled out by angiography. Eighteen fluoro-fluoro deossiglucosio (18F-FDG) positron emission tomography (PET/CT) showed a large hypometabolic area corresponding to the lesion. We waited for patient’s improvement. Late magnetic resonance images revealed a low-grade glioma at the bleeding site. Tumour was removed and histopathologic examination revealed a WHO grade II mixed glioma. The authors emphasize that this evidence has to be kept in mind since it has important therapeutic implications 9).

Memon et al., treated three cases of brain tumor that presented with intracranial hemorrhage. Two of the three tumors were metastatic. They presented with hemorrhage into the tumor, but no blood in the cerebrospinal fluid. One tumor was a low grade astrocytoma that presented as subarachnoid and intraventricular hemorrhage in a 15-year-old child. It was removed with no neurological sequelae 10).



Gottfried ON, Fults DW, Townsend JJ, Couldwell WT: Spontaneous hemorrhage associated with a pilomyxoid astrocytoma: Case report. J Neurosurg 99: 416-420, 2003

Kondziolka D, Bernstein M, Resch L, Tator CH, Fleming JF, Vanderlinden RG, Schutz H: Significance of hemorrhage into brain tumor: clinicopathological study. J Neurosurg 67:852–857, 1987

Licata B, Turazzi S: Bleeding cerebral neoplasm’s with symptomatic hematoma. J Neurosurg Sci 47:201–210, 2003

Mineo JF, Bordron A, Baroncini M, Maurage CA, Ramirez C, Siminski RM, Berthou C, Dam Hieu P: Low HER2-expressing glioblastomas are more often secondary to anaplastic transformation of low-grade glioma. J Neurooncol 85:281-287, 2007

Radulović D: Natural history of supratentorial low-grade astrocytoma: Case report. Srp Arh Celok Lek 134:537-540, 2006

Tungaria A, Sahu RN, Kumar R, Srivastava A: Intratumoral hemorrhage in brainstem low-grade glioma. Neurol India 60: 243-245, 2012

Matsuura C, Sakaeyama Y, Node Y, Ueda K, Ando S, Masuda H, Kondo K, Harada N, Nemoto M, Sugo N. [Diffuse Astrocytoma with Pilomyxoid Features Presenting as Intratumoral Hemorrhage:A Case Report]. No Shinkei Geka. 2018 Dec;46(12):1073-1079. doi: 10.11477/mf.1436203870. Japanese. PubMed PMID: 30572304.

Joković M, Bogosavljević V, Nikolić I, Jovanović N. Spontaneous Intracerebral Hematoma in Low-Grade Glioma After 14 Years of Follow-Up. Turk Neurosurg. 2016;26(3):452-5. doi: 10.5137/1019-5149.JTN.11004-14.1. PubMed PMID: 27161476.

Della Puppa A, Zustovich F, Gardiman M, Manara R, Cecchin D, Scienza R. Haemorrhagic presentation of low-grade glioma in adults. Acta Neurochir (Wien). 2007 Nov;149(11):1151-5; discussion 1155. Epub 2007 Aug 6. Review. PubMed PMID: 17676407.

Memon MY, Neal A, Imami R, Villareal N. Low grade glioma presenting as subarachnoid hemorrhage. Neurosurgery. 1984 May;14(5):574-7. PubMed PMID: 6728165.

New Book: Hemorrhagic Stroke

Hemorrhagic Stroke (Emergency Management in Neurology)

Hemorrhagic Stroke (Emergency Management in Neurology)

By Edoardo Boccardi, Marco Cenzato, Francesco Curto, Marco Longoni, Cristina Motto, Valentina Oppo, Valentina Perini, Simone Vidale

List Price: $54.99
This book provides detailed practical guidance on the management of hemorrhagic stroke in the clinical settings encountered in daily practice. Real-life cases are used to depict a wide range of clinical scenarios and to highlight significant aspects of management of hemorrhagic stroke. In addition, diagnostic and therapeutic protocols are presented and helpful decision-making algorithms are provided that are specific to the different professionals involved in delivery of stroke care and to differing types of hospital facility. The coverage is completed by the inclusion of up-to-date scientific background information relevant to diagnosis and therapy. Throughout, the approach adopted is both practical and multidisciplinary. The book will be of value for all practitioners involved in the provision of stroke care, and also for medical students.

Product Details

  • Published on: 2016-06-21
  • Original language: English
  • Number of items: 1
  • Dimensions: .0″ h x .0″ w x .0″ l, .0 pounds
  • Binding: Paperback
  • 145 pages

About the Author
Eduoardo Boccardi gained his MD in 1978 at the University of Milan, Italy, and then completed specializations in Neurology and Radiology. He has been a member of the Neurosurgical Department of Niguarda Ca’ Granda Hospital, Milan since 1981 and a full-time interventional neuroradiologist since 1990. He has been Director of Interventional Radiology at Niguarda Ca’ Granda Hospital since 2002 and in 2009 was appointed Director of the Department of Neuroradiology. On average he attends 400 procedures for the treatment of intra- and extracranial vascular diseases each year, as principal operator or tutor.
Marco Cenzato has been Director of the Neurosurgery Unit at Niguarda Ca’ Granda Hospital, Milan, since 2011. From 1989 to 2005 he worked as a neurosurgeon at Ospedale San Raffaele di Milano, and his previous positions also include Director of the School of Specialization in Neurosurgery at the University of Brescia and Director of the Neurosurgery Unit at Ospedaliera spedali Civili di Brescia, Italy.
Francesco Curto is an attending physician at Niguarda Ca’ Granda Hospital, Milan and has been responsible for coordination of the Neurocritical Care Unit since 2013. He graduated in 2002 from the University of Milan and then specialized in Anesthesia and Critical Care. He also spent 2 years as a Visiting Fellow at National Institutes of Health (NIH), Bethesda, MD, USA.
Marco Longoni completed his medical studies at the University of Milano-Bicocca, Italy, in 2001 and then undertook a residency and fellowship in Neurology at the university. He has also since completed a fellowship in Radiology. He currently works at the Niguarda Ca’ Granda Hospital in Milan, having previously been a neurologist in the Neuroscience Department at Lecco Hospital, Italy (2007–14).
Cristina Motto graduated in Medicine and Surgery at the University of Milan in 1990 and completed her specialization in Neurology at the university in 1995. Since 2008 she has been a member of the Stroke Unit of Niguarda Ca’ Granda, Milan. She is also a Lecturer on the Nursing Degree in the Faculty of Medicine, University of Milan, and a Member of the Clinical Committee of the Cochrane Neurological Field.
Valentina Oppo gained her MD from the University of Cagliari, Italy in 2009 and subsequently undertook residencies at the University of Cagliari and the University of Milano-Bicocca. She completed her specialization in Neurology at the University of Milano-Bicocca in 2015 and is currently a Fellow in the Neurology Department at Niguarda Ca’ Granda Hospital, Milan.Valentina Perini completed her degree in Medicine and Surgery at the University of Palermo, Italy, in 2008. She entered the Neurology residency program at the university in 2011 and since April 2015 has been undertaking a traineeship in the Stroke Unit at Niguarda Ca’ Granda Hospital in Milan.Simone Vidale graduated in Medicine and then specialized in Neurology at the University of Insubria, Varese, Italy. He currently works in the Department of Neurology, Sant’Anna Hospital, Como, Italy, focusing on strokes, neurological emergencies, and Alzheimer’s disease and other dementias. He served as National Secretary of the Italian Association Against Stroke from 2007 to 2009 and was co-author of chapters on risk factors and primary prevention in the Italian Stroke Guidelines.
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