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Hemorrhagic presentation of a DICER-1–mutant primary intracranial sarcoma with negative MR spectroscopy: illustrative case

Year: 2026

Type: article

Abstract: BACKGROUND: Spontaneous intraparenchymal hemorrhage (IPH) carries significant morbidity and mortality. The etiology of secondary spontaneous IPH, which results from an underlying mass lesion or vascular anomaly, may be obscured on radiographic investigation by the overlying hemorrhage, even when advanced imaging modalities are used. This may lead to a delay in both diagnosis and initiation of targeted therapy. OBSERVATIONS: A 55-year-old man presented multiple times over an approximately 5-month period with recurrent, symptomatic right frontal IPH. During his initial evaluations, multiple imaging modalities, including MR spectroscopy, failed to identify an underlying lesion. Only on his most recent presentation did MRI demonstrate evidence of a hemorrhagic mass, which was subsequently resected and found to be a primary intracranial sarcoma. LESSONS: This case demonstrates the need to interpret negative MR spectroscopy results with caution in cases of hemorrhagic neoplasms. Furthermore, it highlights the difficulty when determining optimal resection timing in cases of spontaneous IPH without a clear etiology. https://thejns.org/doi/10.3171/CASE25899.

Source: Journal of Neurosurgery Case Lessons

DOI: 10.3171/case25899

Authors: Elias Geist, Callum D. Dewar, Richard Crawford, Natalia M. Kuhn, Brian Curry, Michael J. Cirivello

Institutions: Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences

Language: English

Topic: Intracerebral and Subarachnoid Hemorrhage Research

Subfield: Neurology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

OpenAlex ID: W7140198769

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