Clinical reasoning: a rare cause of subarachnoid hemorrhage

Diffuse subarachnoid hemorrhage following ventriculo-peritoneal shunt insertion for acute obstructive hydrocephalus from large glomus jugulare tumor: case report

Background

Glomus jugulare tumors (GJTs) are rare intra-cranial tumors. Commonly, these lesions present with cranial nerve palsies, headaches, and hydrocephalus. Rarely, GJTs present with spontaneous subarachnoid hemorrhage. However, there has never been a report of diffuse subarachnoid hemorrhage following ventriculoperitoneal shunt insertion in a patient who developed hydrocephalus secondary to any brain tumor in general or glomus jugulare tumors in particular.

Observation

The authors presented an extremely rare complication of diffuse subarachnoid hemorrhage following the insertion of a ventriculoperitoneal shunt (VPS) in a 61-year-old female patient who was diagnosed to have both clinical and radiologic features of acute obstructive hydrocephalus secondary to a highly vascular huge glomus jugulare tumor.

Conclusion

Subarachnoid hemorrhage following ventriculoperitoneal shunt insertion for hydrocephalus caused by a mass lesion is an extremely rare complication. Preoperative CT angiography should be strongly considered to look for the associated vascular malformations in extremely vascularized mass lesions. Given the not ubiquitous availability of all therapeutic options for GJTs, especially in low and middle income settings contributes for the poor outcome of GJTs and it fosters a global neurosurgery agenda.

Stress-Induced Subarachnoid Hemorrhage: A Case Report

While there are many forms of intracranial hemorrhage (ICH), the most common form affecting young to middle-aged patients is subarachnoid hemorrhage (SAH). SAHs are primarily traumatic, while a minority of cases are spontaneous. The majority of spontaneous SAHs occur due to the rupture of a cerebrovascular aneurysm. A small number of spontaneous SAHs occur without any objective findings of an aneurysm. Most of these cases are in older patients with certain risk factors such as smoking, hypertension, and alcohol use. This article reports a young female patient without any known significant risk factors who developed an acute spontaneous SAH while experiencing a significant psychological stressor. Recent literature has focused on certain somatic manifestations of psychological stressors, such as stress-induced (Takotsubo) cardiomyopathy. We postulate that our patient’s SAH was a sequela of psychological stress and that the pathophysiology may be similar to Takotsubo cardiomyopathy.

SUBARACHNOID HAEMORRHAGE DUE TO THE RUPTURE OF A HIGH FLOW ANEURYSM DEVELOPED ON AN INTRADURAL ARTERY FEEDING A JUGULOTYMPANIC PARAGANGLIOMA

BACKGROUND

Head and neck paragangliomas are extradural masses rarely associated with subarachnoid haemorrhage.

CASE

This case, for the first time, reports a fatal subarachnoid haemorrhage due to the rupture of a high-flow aneurysm located on an intradural artery feeding a jugulotympanic paraganglioma. Interestingly, this aneurysm was not present on an angiogram performed 7 years before, during the pre-surgical embolization of the tumour.

CONCLUSIONS

To avoid fatal consequences, a preventive investigation of potential aneurysms located on intradural vessels feeding paragangliomas may be suggested.