Hypoglossal neurinoma presenting with intratumoral hemorrhage

Focal or microscopic hemorrhage in a neurinoma is common, but tumor origin from the hypoglossal nerve and extensive symptomatic intratumoral hemorrhage are both rare. A 59-year-old male presented with severe neck pain, nausea and vomiting of 1-day duration, accompanied by right hypoglossal nerve pulse. Neuroimaging disclosed a tumor located in the right cerebellomedullary fissure and containing a hematoma. The right hypoglossal canal was slightly dilated. The intracranial tumor was resected via a suboccipital approach. Histological examination demonstrated spindle-shaped tumor cells with nuclear palisading and also relative hypervascularity with hyaline degeneration of the vessels. Extensive hemorrhage was present, as was necrosis. Thickening and hyalinization of arterial walls, a common occurrence in neurinomas, may have contributed to symptomatic intratumoral hemorrhage.