Brain Meningiomas Manifesting as Intracranial Hemorrhage: Comprehensive Systematic Review and Report of the First Case of Hemorrhagic Meningiomatosis

-OBJECTIVE: To characterize the salient features of hemorrhagic manifestation of meningiomas and to report on the first case of hemorrhagic meningiomatosis.-METHODS: A comprehensive systematic review of the English-language literature was performed using MEDLINE, PubMed, and Google Scholar data-bases to identify case reports and series of brain meningiomas manifesting as intracranial hemorrhage.-RESULTS: A total of 65 patients were evaluated. Most patients were female (64.6%). The average age at presentation was 58.1 +/- 14.3 years. The most common presenting symptom was focal neurologic deficits (n = 47; 71.2%). Identification of tumor was missed/not possible in 24.6% of patients. The most common reported comorbidity was hypertension. Most tumors were located in convexity (n = 36; 55.3%). Subdural hematoma (+/- other hemorrhages) was the most common type of intracranial hemorrhage (n = 46; 70.7%). Computed to-mography hyperintensity (25.7%) and magnetic resonance imaging T2 hypo -intensity (22%) were the most prevalent radiologic findings. The predominant histopathology subtype was meningothelial (syncytial) (n = 24; 36.4%). The estimated mortality was 13.8%. Among those who survived, 39.9% had residual deficits at a median follow-up of 8.1 +/- 5.8 months.-CONCLUSIONS: Intracranial hemorrhage induced by meningiomas is asso-ciated with significant mortality and morbidity. Identifying unexpected menin-gioma in the setting of intracranial bleed can help optimize preoperative planning (e.g., surgical approach) and facilitate total resection of the underlying tumor. Therefore, clinicians should have a high index of suspicion with a low threshold for investigation of meningiomas in the setting of intracranial hemorrhage.