This 60-year old male presented with a headache for 1 week. CT brain showed right temporal intraparenchymal hemorrhage with an isodense lesion at the center of hematoma, right frontotemporoparietal SDH, which suggests a ruptured right MCA branch aneurysm/hemorrhagic space-occupying lesion.

CT cerebral angiogram did not show any evidence of aneurysm/AVM. MRI brain showed a right temporal hemorrhagic neoplastic lesion. The patient underwent emergency right frontotemporoparietal decompressive craniectomy, excision of the right temporal lesion, evacuation of SDH and ICH.

Histopathology report revealed gliosarcoma. Angiosarcomatous components in gliosarcoma increase the risk of hemorrhage. 

Acknowledgement:

Dr Shriram Varadharajan DM, Dr Meena Nedunchelian DNB, (Neuroradiology)

Dr Rajesh Shanker Iyer DM (Neurology),

Dr Suresh Jayabalan MCh (Neurosurgery) 

Dr Sangita S Mehta MD, Dr Rajeshwari MD (Pathology)

Kovai Medical Center & Hospital, Coimbatore, India