a dangerous acute presentation of hemorrhagic meningioma

Background and importance: meningioma is one of the most common intracranial tumors. its incidence rate is 37.6% of all primary brain tumors and 53.3% of benign tumors. hemorrhagic meningioma is rare, with only 120 cases reported in the literature between 1980-2021. the most common type of hemorrhagic meningioma is acute subdural hematoma (sdh) and then intraparenchymal (iph) (49 cases and 44 cases, respectively, approximately one case per year). the risk of rebleeding in this case is high (74%), therefore prompt surgical treatment is recommended. case presentation: the presenting case is a very rare hemorrhagic meningioma associated with sdh and iph. a 69-year-old woman with a history of hypertension complained of severe and sudden headaches and mild confusion. he had no anticoagulant in her drugs. brain computed tomography (ct) and magnetic resonance imaging (mri) showed right frontoparietal meningioma with acute sdh and associated iph with midline shift. the patient was operated and the tumor was resected, the hematoma was evacuated and then discharged in good condition. conclusion: each acute sdh and iph is a rare presentation of meningiomas and their association as in this case is extremely rare. due to the high risk of rebleeding in similar reported cases, prompt surgical treatment is recommended. a precise understanding of pathogenesis needs to be evaluated in these cases.