Intracranial malignant glioma presenting as subarachnoid hemorrhage

Objective: Cerebral aneurysms are the predominant cause of spontaneous subarachnoid hemorrhage (SAH). However, if an aneurysmal cause has been excluded, there remains but a short list of other potential etiologies. Cerebral neoplasms are clearly on this list but are most commonly meningiomas or metastatic lesions. This article details a case of a neoplasm that presented exclusively with SAH. Clinical Presentation: A 40-year-old male presented with a SAH with normal cerebral angiography. The initial magnetic resonance image revealed a lesion in the right insula thought to be resolving hemorrhage. Subsequent images, however, revealed the mass to be enlarging. Intervention: Craniotomy and resection of the lesion established a diagnosis of a malignant oligodendroglioma. Conclusion: An affirmation is made that patients experiencing 'angiographically-negative' SAH should undergo MRI, occasionally on a serial basis, to exclude other etiologies for hemorrhage, including neoplasia.