To present and discuss the clinical features, neuroimaging, and neuropathologic findings of cerebellar meningioangiomatosis in a 50-year-old female who presented to the neurointensive care unit with traumatic subarachnoid hemorrhage (SAH).

Meningioangiomatosis is a rare, often benign lesion of the leptomeninges and underlying cortex, typically manifesting as headache and seizures due to its classical location.  We present a rare case of meningioangiomatosis of the cerebellum.

A 50-year-old woman with past medical history of medulloblastoma (status-post resection and radiation), breast cancer (status-post lumpectomy and chemotherapy complicated) and 8 months of headache, worsening vertigo and dysequilibrium was admitted to the neurointensive care unit after a witnessed fall with head trauma. CT non-contrast head showed diffuse SAH. Diagnostic cerebral angiogram on admission showed no aneurysm but demonstrated right middle cerebral artery (MCA) and bilateral anterior cerebral arteries (ACAs) vasospasm presumed secondary to traumatic SAH. Lumbar puncture was non-inflammatory and non-infectious. During her hospitalization she developed multifocal infarcts related to vasospasm, treated with intra-arterial verapamil, balloon angioplasty, and vasopressor support. She was empirically treated with pulse steroids for ongoing vasospasm pending rheumatological studies (with marginal improvement). The patient developed acute respiratory distress syndrome (ARDS) and was compassionately extubated 2 weeks after admission in accordance with previously expressed wishes. Autopsy was performed and neuropathologic examination revealed known SAH and meningioangiomatosis in the left cerebellar hemisphere.