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, Study Design: Case report and review of the literature. Setting: University-based, tertiary referral center. Patient: 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. Interventions: The patient was admitted to the intensive care unit and treated with vitamin K and corticoids. Main Outcome Measures: 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. Conclusion: Intratumoral, subarachnoid, and brainstem hemorrhages can occur in patients with vestibular schwannoma. Oral anticoagulant therapy is a risk factor for tumor-related hemorrhage.