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Meningioma, cystic

CLINICAL HISTORY:
This 59-year old man presents with a two month history of morning headaches and tinnitus on the left. He mentions problems with writing, speech and counting, as well as memory disturbances. Moreover he complains of weakness and numbness in the right leg.

NEUROLOGICAL EXAMINATION reveals a right hemiparesis. Furthermore speech disturbances, difficulties with counting, left-right confusion and constructional apraxia fit into a typical Gerstmann syndrome.

CT:
a) NON-CONTRAST SCAN (IMAGE 1): There is a small hyperdense nodule (arrow) against the left parietal convexity, surrounded by a more multicystic component (arrowheads).

b) CONTRAST-ENHANCED SCAN (IMAGES 2 AND 3): Intense enhancement of the nodule (arrow), surrounded by a polycystic component (arrowheads).

MRI:
a) TRANSAXIAL T2-WEIGHTED (2500/90/1) SPIN-ECHO SEQUENCE (IMAGE 4): Confirmation of a small rather hypointense mass (arrow) against the left parietal convexity. More peripherally a well-circumscribed cystic component (arrowheads) can be seen. Note the presence of edema.

b) TRANSAXIAL T1-WEIGHTED (600/20/1) SPIN-ECHO SEQUENCE (IMAGE 5): Note again the two components of the tumor.

c) TRANSAXIAL (IMAGE 6), CORONAL (IMAGE 7) AND SAGITTAL (IMAGE 8) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: The solid component shows homogeneous enhancement (arrow) with evidence of a small dural tail. The cystic component (arrowheads) shows some enhancement (long arrow image 7) at its periphery.

RADIOLOGICAL DIAGNOSIS is meningioma with a cystic component, mainly based on the broad implantation on the dura of the convexity. In the differential diagnosis ganglioglioma should be considered.

SURGICAL FINDINGS: At surgery a meningioma was found with a true cystic component.

ANATOMOPATHOLOGY was consistent with meningioma Grade I.

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Fig. 1

Meningioma, cystic, Fig. 1
Meningioma, cystic, Fig. 2
Meningioma, cystic, Fig. 3
Meningioma, cystic, Fig. 4
Meningioma, cystic, Fig. 5
Meningioma, cystic, Fig. 6
Meningioma, cystic, Fig. 7
Meningioma, cystic, Fig. 8