Presentation
Right-sided loss of vision, along with intractable headache.
Patient Data
Right sphenoid-based, well-defined, extra-axial (CSF Cleft sign) lesion iso-intense in T1 (not shown) and T2 to brain parenchyma, and displaying homogenous intense contrast enhancement with dural tail. It exerts a mass effect upon the intracranial segment of the right optic nerve and third ventricle, along with a significant midline shift (11 mm). It is surrounded by grade II vasogenic edema.
The lesion abuts the right internal carotid artery, which remains patent (signal void).
Supratentorial hydrocephalus is more so on the right.
Axial CT cuts (study done as a complementary after MRI+Gd; hence the enhancement) show a well-defined SOL with no bone erosion and non-appreciable hyperostosis.
Case Discussion
The presence of the following features suggests the diagnosis of a meningioma:
extra-axial location; CSF Cleft sign
homogenous contrast enhancement
dural tail enhancement
Unfortunately, further clinical and imaging follow up is unavailable for this patient.
Case Courtesy: Tamer Elrefaiy, MD, Ass. Prof. Heba Abd-Elmoneem, Prof. Faten Fawzy.
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