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Brain Tumor as a Cause of Hemorrhagic Stroke

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Updated November 02, 2008

Head CT showing bleeding in the brain
Photo © A.D.A.M.
Although brain tumors can cause strokes, their symptoms develop differently from typical stroke symptoms. This is because most strokes happen due to a sudden blockage of blood flow to a part of the brain, which causes symptoms to develop suddenly. By contrast, tumors are masses that grow relatively slowly into the brain tissue, causing symptoms to develop just as slowly, over days, weeks, months or even years. But when a brain tumor bleeds, it can cause symptoms that are identical to those of a typical hemorrhagic stroke.

Hemorrhagic strokes caused by bleeding from a brain tumor are relatively rare events, accounting for, depending on the study, 1-10% of all causes of intracerebral hemorrhage (ICH). More common causes of ICH include high blood pressure, amyloid angiopathy, AVM, cavernous malformations, and trauma.

A brain tumor's tendency to bleed depends on whether it is benign, malignant, primary, or metastatic. Furthermore, specific types of brain tumors have different properties, which make them more or less likely to bleed. For instance, up to 15% of all pituitary adenomas cause bleeding, while meningiomas rarely do.

What Are the Symptoms?

The symptoms of bleeding from a brain tumor depend on the amount of blood that enters the brain tissue, and where the bleeding took place. Thus, symptoms can range from a simple headache to a life-threatening paralysis. The latter, however, is a rare event and the symptoms usually involve a headache associated with any of the following:
  • Weakness of the face and/or arm, and/or leg on one side of the body
  • Numbness in the face, and/or arm, and/or leg one side of the body
  • Inability to understand spoken language or inability to speak
  • Inability or difficulty writing or reading
  • Vertigo and/or gait imbalance with or without nausea or vomiting
  • Severe headache or double vision

How Is It Diagnosed?

Bleeding from a brain tumor is usually diagnosed by a head CT. In this test, the ICH appears as a bright white area inside the normal brain tissue that is typically surrounded by a darker area of swelling, caused by the tumor. This area of swelling helps doctors to differentiate brain-tumor induced ICH from other causes such as high blood pressure or AVM. Once there is a suspicion that bleeding is caused by a tumor, physicians usually perform an MRI of the brain with a contrast known as gadolinium, which allows blood vessels to be visualized and reveals the tumor with greater clarity.

What Is the Treatment?

The treatment of an ICH that was caused by a brain tumor depends on the amount of blood and the symptoms it causes. The standard treatment is to remove both the blood and the tumor at the same time. However, in cases in which the amount of bleeding is very small, and the patient’s symptoms are minor (e.g., headache), it is not always clear when such a surgery should take place. Some physicians advocate for immediate removal of the tumor even in these mild cases, as some tumors are known to re-bleed and cause patients to become critically ill.

Read more about brain tumors

Sources:

Source: J. P. Mohr, Dennis W. Choi, James C. Grotta, Bryce Weir, Phillip A. Wolf Stroke: Pathophysiology, Diagnosis, and Management Churchill Livingstone; 4th edition (2004)

Inamasu , Y . Nakamura , R . Saito , Y . Kuroshima , K . Mayanagi , K . Ichikizaki Rebleeding from a primary brain tumor manifesting as intracerebral hemorrhage (CNN 04/077, revised version) . Clinical Neurology and Neurosurgery;108 (1);105 – 108.

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