Thoracic meningioma presenting subarachnoid haemorrhage

A 67 year-old-female developed sudden lumbago followed by headache and urinary retention. On the following day, she began to suffer from dysaesthesia affecting the left thigh. One week after the onset lumbar puncture revealed xanthochromic CSF. An extensive radiological survey on the 1 lth day disclosed an abnormal intensity area on the spinal MR image at the lower thoracic level. The patient was referred to our clinic on the 18th day after the onset. MR imaging with and without Gd-DTPA enhancement was performed on the 30th day after the onset. T1 weighted-images demonstrated an enhanced lesion at the thoracic cord level from Thl0 to Th12. Myelography on the 36th day revealed a filling defect of the contrast dye extending from Thl0 to Thl2 on the left side. CTmyelography showed a clear image of the subarachnoid space with a filling defect in the dorsolateral aspect on the left side (Fig. 1, left). Because of the persistent symptoms, we operated on this patient to remove the mass lesion on the 45th day after the onset of her illness. Hemilaminectomy from Thl0 to Thl2 was performed on the left side. When the dura was opened, a soft tumorous mass was recognized subdurally and was removed. The tumour was not attached to the dura and other structures. The surface of the spinal cord appeared yellowish due to haemosiderin pigmentation. On the basis of these findings, the tumour was thought to be granulomatous tissue with previous haemorrhage. Histological examination revealed a psammomatous meningioma (Fig. 1, right). The postoperative course was uneventful, and the urinary retention disappeared by the 10th postoperative day. The