Hemorrhagic Manifestations of Intracranial Neoplasms

Hemorrhagic manifestations of intracranial neoplasms present a critical intersection of oncological and vascular pathology in the central nervous system. Although primary and metastatic brain tumours typically manifest with progressive neurological deficits and seizures, a subset produces intratumoral or peritumoral haemorrhages that can mimic spontaneous intracerebral bleeds. These haemorrhagic events arise through mechanisms such as tumour-induced neovascularisation with fragile endothelial networks, disruption of the blood–brain barrier and local coagulopathy. High-grade gliomas and metastatic lesions from melanoma, renal cell carcinoma or choriocarcinoma carry the greatest risk of bleeding, owing to their propensity for rapid angiogenesis and necrosis. Clinically, patients may present acutely with headache, focal deficits or altered consciousness, necessitating rapid neuroimaging evaluation. On CT and MRI, haemorrhagic tumours often demonstrate mixed-density lesions with ring-enhancement, surrounding oedema and mass effect. Advanced imaging techniques—such as perfusion MRI and susceptibility-weighted imaging—have enhanced differentiation between pure vascular bleeds and neoplastic haemorrhages, guiding surgical planning. Therapeutic strategies combine neurosurgical evacuation, targeted radiotherapy and chemotherapy tailored to tumour histology, with adjunctive measures to stabilise coagulation. Emerging molecular insights into vascular endothelial growth factor signalling and tumour microenvironment interactions offer prospects for anti-angiogenic therapies aimed at reducing haemorrhagic risk. Global efforts have focused on establishing standardised diagnostic algorithms to differentiate neoplastic haemorrhage from other intracranial bleeds, improving timely intervention and outcomes.

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Hemorrhagic Manifestations of Intracranial Neoplasms publication trend

The graph below shows the total number of articles in hemorrhagic manifestations of intracranial neoplasms across all publications each year (not limited to Nature Index journals).

Technical terms

Intratumoral haemorrhage: Bleeding that occurs within a neoplasm due to rupture of tumour blood vessels or necrotic tissue.

Ring-enhancing lesion: A circular area of contrast uptake on imaging, often indicating a capsule of tumour or abscess surrounding central necrosis or haemorrhage.

Arteriovenous malformation (AVM): A congenital tangle of arteries and veins lacking a normal capillary bed, prone to rupture and bleeding.

Intracranial aneurysm: A bulge in a cerebral artery wall that may coalesce with tumoral vascular networks, increasing risk of rupture.

Hypervascularisation: The formation of an excessive network of blood vessels within tissue, characteristic of high-grade tumours and a key factor in tumour haemorrhage.

References

1. Glioblastoma multiforme subterfuge as acute cerebral hemorrhage: A case report and literature review. Neurology International (2018).
2. A Rare Triploid Involving the Coexistence of Glioblastoma Multiforme, Arteriovenous Malformation and Intracranial Aneurysm: Illustrative Case and Literature Review. Medicina (2023).