Presentation
The patient is sent to the brain MRI by her neurologist because of the occasional headaches and an episode of the left facial nerve palsy.
Patient Data
There is an expansive extra-axial mass in the left cerebellopontine angle with no perilesional edema and mild compressive effect on cerebellar peduncle and left cerebellar hemisphere.
The lesion is hypo to isointense to grey matter on T1W, and hyperintense on T2W/FLAIR sequences, with strong, homogenous postcontrast IS enhancement.
There is also vivid IS postcontrast enhancement of adjacent dura, which gives the characteristic picture of the dural tail, so the findings are most consistent with the meningioma.
The seventh and eight cranial nerves are intact.
There are also multiple ischemic lesions of different age.
Case Discussion
The patient has a long history of hypertension, occasional headaches, few episodes of transient neurologic deficits and most recently, left facial nerve palsy.
The findings are most consistent with meningioma because of position, precontrast and postcontrast characteristics of the lesion.
The patient is sent for a neurosurgeon consultation for treatment.
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