Case history
Case history #1
A 60-year-old woman presents with progressive headache and cognitive decline. A magnetic resonance imaging (MRI) scan of the brain, without gadolinium enhancement, demonstrates a large extra-axial lesion that is of a similar intensity to brain on T1 images.[Figure caption and citation for the preceding image starts]: Sagittal image (left) demonstrates large extra-axial mass isointense with brain; after contrast administration, the lesion avidly enhances, as shown in the coronal image (centre left) and axial image (centre right). Note the extensive oedema surrounding the tumour on the T2 axial image (right)From the personal library of Dr William T. Couldwell; used with permission [Citation ends].
After contrast administration, the lesion enhances avidly. The tumour was removed by craniotomy and the patient has been followed with serial imaging studies (once per year) with no evidence of recurrence after 6 years.
Case history #2
A 35-year-old man presents with visual loss in his left eye and diplopia. MRI demonstrates a lesion involving the cavernous sinus.[Figure caption and citation for the preceding image starts]: Axial contrast-enhanced image demonstrates meningioma in the cavernous sinus on the left sideFrom the personal library of Dr William T. Couldwell; used with permission [Citation ends].
The lesion was removed subtotally to reduce the tumour to a minimal volume and the residual tumour was treated with stereotactic radiosurgery.
Other presentations
The clinical presentation of patients with meningioma will depend on the anatomical location of the tumour and associated mass effect. Neurological deficit can include cranial nerve deficit, deficit from mass on local cortex (paresis, sensory deficit, or speech), or cognitive decline from large tumours or from tumours that cause obstructive hydrocephalus. Tumours of the spinal dura will present with extremity weakness and spasticity, and possible sensory or bowel/bladder involvement depending on the spinal level.
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