What are the key findings on the MRI?
The left parafalcine meningioma is compatible with a meningioma, with adjacent brain reaction. There is also a large right parietal convexity meningioma - which was occult on the MRI. This would correspond with the left sensory presentation. In addition, there are a number of cavernomas without acute features.
Is there any connection between these different findings?
Multiple meningiomas can be seen in a number of settings, including spontaneous meningiomas and neurofibromatosis type 2 (typically associated with schwannomas and / or ependymomas). When multiple cavernomas or microbleeds are seen - as in this case - these can be seen many years following radiotherapy treatment.
As identified on CT there is a 17 mm left parafalcine enhancing mass. This has a slender dural tail. Subcortical oedema in the left superior frontal and cingulate gyri.
There is also a 33 x 13 mm right parietal convexity mass - which on review of the CT is of very similar density to the adjacent brain. There is dural thickening under most of the right parietal and temporal bones. This is directly in contact and displacing the right post central gyrus / sensory strip, which is likely contributing to the presentation, but there is no oedema or parenchymal signal change.
No other meningiomas. The two supratentorial lesions do not demonstrate calcification on the SWI sequences.
There is minor calcification associated with the left cerebellar lacune.
However there are also a number of cavernous malformations / cavernomas, with high signal matching blood vessels on the phase part of the SWI sequences. Locations include the left frontal pole, right caudate head, right temporal stem and right operculum.