Spontaneous Subdural Hemorrhage Revealing a Meningioma in Pregnancy: A Rare Neurosurgical Emergency — A Case Report and Literature Review

Although most meningiomas are benign, slowly growing tumors that can be asymptomatic and discovered incidentally, they can scarcely present for the first time as spontaneous intracranial hemorrhages. This case report presents a pregnant woman who was misdiagnosed with extradural hemorrhage (EDH) only to discover intraoperatively that it was a subdural hematoma (SDH) overlying a meningioma.The patient presented with a five-day history of headache and newly developed drowsiness, blurring of vision and vomiting on the day of admission. After excluding possible obstetric causes, a magnetic resonance imaging (MRI) was performed, revealing features of EDH. The decision for evacuation was made, and during preoperative preparation, her GCS score deteriorated to 9. After the bone flap was elevated, no EDH was found. Opening the dura revealed an SDH overlying a bluish grayish tumor. Evacuation and total excision of the tumor were successfully performed, adequate hemostasis was achieved, and histopathology revealed a meningothelial meningioma (WHO grade I) with intratumoral bleeding. The patient was discharged after 6 days with no complications.This unique case highlights the importance of considering intracranial hemorrhage as a differential diagnosis for pregnant patients presenting with neurological symptoms such as headache and blurred vision, among other obstetric differentials such as preeclampsia and eclampsia, making the diagnosis more challenging. Additionally, we should consider the presence of meningioma as a cause of unexplained intracranial hemorrhage to be surgically prepared to address it intraoperatively in the setting of not being diagnosed beforehand to ensure complete resection and prevent rebleeding.