Intratumoral and brainstem hemorrhage in a patient with vestibular schwannoma and oral anticoagulant therapy.
OBJECTIVE
To report the first case of spontaneous intratumoral and brainstem hemorrhage in a patient with a vestibular schwannoma.


METHODS
Case report and review of the literature.


METHODS
University-based, tertiary referral center.


METHODS
A 73-year-old woman with a vestibular schwannoma, anti-vitamin K overdose, and arterial hypertension experienced a rapid onset of headache, facial palsy, diplopia, and hoarseness.


METHODS
The patient was admitted to the intensive care unit and treated with vitamin K and corticoids.


METHODS
Clinical and radiologic findings.


RESULTS
At admission, the magnetic resonance imaging and computed tomographic scans showed an intratumoral hemorrhage. The patient entered a coma 24 hours after the onset of the symptoms. At that time, the computed tomographic scan demonstrated a massive intratumoral and brainstem hemorrhage. The patient died 3 days later.


CONCLUSIONS
Intratumoral, subarachnoid, and brainstem hemorrhages can occur in patients with vestibular schwannoma. Oral anticoagulant therapy is a risk factor for tumor-related hemorrhage.
Vellin
Jean-François
JF
Department of Otolaryngology, Hôpital Beaujon, AP-HP, Clichy, France.
Bozorg Grayeli
Alexis
A
Kalamarides
Michel
M
Fond
Cyril
C
Bouccara
Didier
D
Sterkers
Olivier
O
D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001933:Brain Stem / Q000473:pathology*; D004172:Diplopia; D062787:Drug Overdose; D005158:Facial Paralysis; D017809:Fatal Outcome; D005260:Female; D006261:Headache; D006685:Hoarseness; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced / Q000175:diagnosis / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D009464:Neuroma, Acoustic / Q000150:complications* / Q000473:pathology; D014057:Tomography, X-Ray Computed
D000925:Anticoagulants