A Case of Convexity Meningioma Presenting With Acute Subdural Hematoma: A Case Report With a Pooled Analysis of 63 Reported Cases.

Meningioma-associated acute subdural hematoma (ASDH) is an exceedingly rare clinical entity, and its hemorrhagic mechanisms remain poorly understood. A 65-year-old man presented with progressive headache without a history of trauma. Neurological examination revealed no focal deficits. Computed tomography demonstrated a left convexity acute subdural hematoma, while magnetic resonance imaging revealed a small adjacent extra-axial lesion with mild contrast enhancement. Digital subtraction angiography showed only minimal tumor staining and no evidence of vascular malformation. The patient underwent gross total resection of the tumor and evacuation of the hematoma. Histopathological examination confirmed a meningothelial meningioma with focal disruption of intratumoral venous structures, intratumoral hemorrhage, necrosis, and focal areas of increased proliferative activity. The postoperative course was uneventful, and the patient recovered without neurological deficits. Previously reported cases are discussed to provide clinical context and highlight the diverse presentations and management strategies of this rare condition. Although rare, meningioma should be considered a potential source of non-traumatic ASDH. Because reliable preoperative predictors of hemorrhage have not been established, management should be individualized according to tumor-hematoma continuity, neurological status, surgical feasibility, and patient preferences.