Intratumoral Hemorrhage within Petrous Meningioma

BACKGROUND: Intracranial hemorrhage stemming from a benign intracranial lesion is much less commonly seen than from malignant tumors such as gliomas or metastases. Cerebellopontine angle (CPA) lesions rarely present with hemorrhage. CASE DESCRIPTION: We describe the case of a 49-year-old male with a recurrent right CPA meningioma arising from the petrous bone that was previously treated with a subtotal resection and postsurgical radiosurgery, presenting with acute left-sided hemiparesis secondary to intratumoral hemorrhage. Although surgical evacuation and decompression were recommended, the patient declined operative intervention and was managed medically. CONCLUSIONS: Meningiomas can cause subarachnoid, intraparenchymal, and rarely intratumoral hemorrhage. Symptomatic hemorrhage can worsen the prognosis, with increased morbidity and mortality. Several etiologies have been proposed for this phenomenon including rupture of aberrant vasculature, intratumoral necrosis, and tearing of stretched bridging veins. Only 2 prior cases of CPA meningioma have been reported in the literature. Recognition of CPA meningioma hemorrhage as a clinical entity can help in future diagnoses and management.