Very small vestibular schwannoma as the source of fatal subarachnoid hemorrhage: a case report

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.

Keywords:

• Vestibular schwannoma
• subarachnoid hemorrhage
• case study

Acknowledgment

We thank Nancy Schatken, BS, MT(ASCP), from Edanz Group (https://en-author-services.edanzgroup.com/), for editing a draft of this manuscript.

Author contributions

Masafumi Kuroiwa: Writing, original draft preparation and editing.

Takahiro Murata: Supervision, validation.

Shuichi Hirayama: Supervision.

Masanobu Hokama: Supervision.

Toshihiko Miyashita: Supervision.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.