PMC3812785_01
Axial computed tomography demonstrates an acute inter-hemispheric haemorrhage. B) Sagittal T1-weighted sequence. C) Axial
post-gadolinium T1-weighted sequence. D) Coronal post-gadolinium T1-weighted sequence, indicating tumour location.
TONIJ-7-32_F1.jpg
PMC3812785_01_TONIJ-7-32_F1.jpg
F1
A computed tomography (CT) scan revealed a rounded mass of 3.3 cm within the intra-hemispheric region, and it was associated with acute haemorrhage, which was predominantly in the right postero-medial frontal area (Fig. 1A). T2-weighted sequences and contained multiple foci of increased T1 signal. This was in line with a haemorrhage (Fig. 1B, C, D). 
The initial negative conventional cerebral angiogram of the left internal carotid artery. B) The pre-operative angiogram of the same
vessel when the aneurysm was found (arrow). C) The aneurysm was visualised more minutely with an angiographic micro-catheter that was
injected in the left anterior cerebral artery.
TONIJ-7-32_F2.jpg
PMC3812785_01_TONIJ-7-32_F2.jpg
F2
No associated vascular abnormalities were observed (Fig. 2A). Four weeks later, a pre-operative cerebral angiogram, which was conducted for the purpose of tumour embolisation, did not reveal any appropriate targets for embolisation; rather, a 3-mm saccular aneurysm was noticed with a left internal artery injection from the distal left pericallosal artery (Fig. 2B, C).
Micro-photographs showing histopathologic findings. A) A meningioma with meningothelial features, fresh haemorrhage and
hemosiderin deposition (brown colour, suggestive of previous haemorrhage). B) An aneurysm (arrows pointing to the neck) at the wall of a
muscular artery. C) The site specified in B) showing aneurysm embolisation N-butyl-2-cyanoacrylate material (yellow colour) and
surrounding reactive changes, including multi-nucleated giant cells. D) The site specified in B) showing aneurysm rupture with surrounding
hemosiderin deposition. Original magnification 200x, A, C and D; 25x, B.
TONIJ-7-32_F3.jpg
PMC3812785_01_TONIJ-7-32_F3.jpg
F3
The final pathology confirmed the diagnosis of a World Health Organization grade-I meningioma with embolisation material within the tumour (Fig. 3).