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  • Title: Very small vestibular schwannoma as the source of fatal subarachnoid hemorrhage: a case report.
    Author: Kuroiwa M, Murata T, Hirayama S, Hokama M, Miyashita T.
    Journal: Br J Neurosurg; 2023 Oct; 37(5):1254-1257. PubMed ID: 33155858.
    Abstract:
    BACKGROUND: Subarachnoid hemorrhage (SAH) is commonly caused by an aneurysm, trauma, other vascular diseases, and infrequently by a metastatic tumor or glioma. SAH due to a benign intracranial tumor, such as a vestibular schwannoma (VS), is rare. We report a case in which a very small (1 mm) VS caused fatal SAH. CASE PRESENTATION: A 75-year-old woman presented with a sudden severe headache. Computed tomography showed SAH at the right of the cerebellopontine angle. On post-onset day (POD) 27, MRI revealed a 1-mm mass on the cerebellopontine angle's right side. She was discharged with House-Brackmann grade 4 right-side facial weakness and hearing disturbance. She re-presented on POD 45 with headache and loss of consciousness. Computed tomography revealed massive SAH and intracerebellar hemorrhage. She died 4 days later. Histopathological evidence indicated a highly vascular vestibular schwannoma. CONCLUSIONS: Vestibular schwannoma should therefore be considered a source of SAH, particularly in patients with facial weakness and/or hearing disturbance.
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