title: Intratumoral and brainstem hemorrhage in a patient with vestibular schwannoma and oral anticoagulant therapy.
abstract: 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.
authors.affiliation: Department of Otolaryngology, Hôpital Beaujon, AP-HP, Clichy, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Vellin
authors.forename: Alexis
authors.initials: A
authors.lastname: Bozorg Grayeli
authors.forename: Michel
authors.initials: M
authors.lastname: Kalamarides
authors.forename: Cyril
authors.initials: C
authors.lastname: Fond
authors.forename: Didier
authors.initials: D
authors.lastname: Bouccara
authors.forename: Olivier
authors.initials: O
authors.lastname: Sterkers
mesh_terms: 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
chemical_list: D000925:Anticoagulants