J.Sales-Llopis

Neurosurgery Department, University General Hospital of Alicante, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Alicante, Spain

Highly-vascularized, primary malignant brain tumors (BTs), including glioblastoma, oligodendroglioma and metastatic BT, tend to bleed spontaneously and should always be included in the differential diagnosis of non traumatic intracerebral hemorrhage ¹⁾.

Clinical and autopsy studies have identified that brain tumors represent 0.9–11% of spontaneous ICH ^{2) 3) 4) 5) 6) 7) 8) 9) 10) 11)}.

Up to 10% of patients with BTs may experience a diagnostic delay if CT is the only imaging modality that is used ¹²⁾.

Dual-energy CT may be useful in detecting underlying tumors in patients with an ICH of unknown origin, and is a useful tool in differentiating between tumor bleeding and pure ICH in patients with acute ICH of an unclear origin ¹³⁾.

Using MRI with gadolinium early in the post-operative period is likely to lead to an earlier detection of the BT. A previous study showed that the use of MR angiography (MRA) aided the disclosure of the development of an intratumoral aneurysm on a dilated feeding artery, the rupture of which led to intratumoral bleeding ¹⁴⁾.

The standard treatment of a BT manifesting as an ICH is the surgical removal of the hematoma and the tumor ^{15) 16)}.

However, the optimal timing of the therapeutic intervention is poorly defined, particularly when the neurological status of the patient is stable following admission and there is only a minimal or no mass effect on the CT scan ¹⁷⁾