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Meningioma, multiple

CLINICAL HISTORY:
This patient was operated several years ago for a sphenoid meningioma on the right side. Other meningiomatous lesions have been previously identified in the posterior fossa. The patient presents now for a routine follow-up examination.

NEUROLOGICAL EXAMINATION is normal.

CONTRAST-ENHANCED CT (IMAGE 1): At least two meningiomas are seen (arrowheads) in the posterior fossa. The left posterior lesion is densily calcified (arrow).

MRI:
a) TRANSAXIAL T2-WEIGHTED (2500/90/1) SPIN-ECHO SEQUENCE (IMAGES 2 AND 3): Multiple extra-axial lesions are confirmed (arrowheads) in the posterior fossa. On the right side a lesion with hyperintense signal is broadly implanted on the petrous bone. On the left side a similar lesion can be seen. Posteriorly a lesion with broader implantation on the convexity is seen with a dense central calcification (arrow).

b) TRANSAXIAL T1-WEIGHTED (600/15/1) SPIN-ECHO SEQUENCE (IMAGE 4): The anterior lesions are isointense to grey matter. Posteriorly the calcification can be seen as very low signal (arrow).

c) TRANSAXIAL (IMAGES 5 AND 6), CORONAL (IMAGE 7) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: The lesions show intense contrast enhancement. All lesions are broadly implanted on the convexity. A fourth lesion (arrowhead) originating from the tentorium is identified.

RADIOLOGICAL DIAGNOSIS is multiple meningiomas.

No surgical confirmation is available. The pathology of the meningioma originally resected was fibrous meningioma.

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Fig. 1

Meningioma, multiple, Fig. 1
Meningioma, multiple, Fig. 2
Meningioma, multiple, Fig. 3
Meningioma, multiple, Fig. 4
Meningioma, multiple, Fig. 5
Meningioma, multiple, Fig. 6
Meningioma, multiple, Fig. 7