gms | German Medical Science

Objective: Spontaneous intracranial hemorrhage (SIH) may be the first clinical manifestation of a brain tumor, whose symptoms and CT features may resemble typical hypertensive bleeding. This doubt can complicate and delay a possible early diagnosis for those cases. The answer for this doubt is of fundamental importance for a favorable outcome. We will expose the diagnostic difficulties between spontaneous intracerebral hemorrhage and those resulting from secondary hemorrhages of space-occupying lesions.

Method: 3694 cases of brain hemorrhage were analyzed, in which 101 were secondary bleeding of brain tumors. In those 101 cases, there were twenty-six cases, between 1979 and 2009, of doubtful diagnosis which occurred between hemorrhagic neoplastic and hemorrhagic stroke. Clinical symptoms, location of intra-cerebral hematoma and CT and MRI image characteristics are demonstrated. Pathological studies reveal the most common tumor lesions. The most frequent locations of intracranial hemorrhage and resolution according to the peiculiarity of each case.

Results: Metastases were the most common tumors that bled. Glioblastoma multiforme was the most common bleeding brain primary tumor. Only 26 cases of 101 bleeding tumor lesions posed diagnostic difficulties. The good outcome in those cases are directly linked to the ability of setting the correct diagnosis of those lesions.

Conclusions: The intratumoral hemorrhage may be the initial manifestation of brain tumors, and sometimes, they are indistinguishable from typical hypertensive SIH, both in clinical and tomographic imaging, making the diagnosis more difficult. Intratumoral hemorrhage is more frequent in brain metastases. Among the primary tumors, glioblastoma multiforme is the most common cause of bleeding. A prompt and correct diagnosis of those lesions are directly linked to the good outcome in those cases.