Cerebral metastases from lung cancer with amyloid angiopathy and cerebellopontine angle meningioma

Case contributed by Ammar Haouimi


Vertigo with left hearing loss in a hypertensive patient.

Patient Data

Age: 65 years
Gender: Female

The MRI sequences demonstrate a well-defined extra-axial soft tissue mass (20x18x15 mm) at the left cerebellopontine angle with broad-based dural attachment, extending into the ipsilateral internal auditory canal with enlargement of the ipsilateral porus acusticus. It displays an intermediate signal intensity on T1WI, mild high signal intensity on T2WI/FLAIR with intense and homogeneous enhancement on postcontrast sequences with "dural tail sign". A mild mass effect is noted on the cisternal portion of the ipsilateral trigeminal nerve and middle cerebellar peduncle.

Prominent subarachnoid space around the optic nerves with flattening of the posterior sclera bilaterally and partially empty sella turcica which may indicate idiopathic intracranial hypertension.

The GE sequence was not performed.

The patient refused surgery. An MRI exam was performed one year later (follow-up for same symptoms) showing:

  • the same extra-axial lesion in the left cerebellopontine angle mass in keeping with a meningioma
  • multiple lesions of various sizes along the surface of the cerebellar and cerebral hemispheres which were not visible on the MRI exam performed one year ago. they display an iso-to low signal to the cortical grey matter on T1WI, slight high signal on T2WI/FLAIR with heterogeneous enhancement on postcontrast sequences suggestive of cerebral metastases; the largest lesions are located in the right frontal and left parietal regions with surrounding edema
  • On axial GE there are numerous corticosubcortical (grey-white matter junction) low signal blooming artifact, sparing the basal gangliapons and cerebellar hemispheres, more consistent with cerebral amyloid angiopathy (not detected on the previous MRI exam because theT2* sequences: GRE, echo-planar, SWI were not performed)

CT scan performed three days after the 2nd MRI exam revealed:

  • multiple mediastinal and left hilar lymphadenopathy as well as para-aortic
  • small spiculated mass (26x21 mm) in the lingula which may represents the primary tumor
  • left pleural irregular nodular thickening (pleural metastases)
  • bilateral adrenal nodules (adrenal metastases)
  • numerous diverticula of the colon/sigmoid are noted

Case Discussion

MRI and CT features of multiple cerebral metastases, probably from lung cancer, with meningioma of the cerebellopontine angle and cerebral amyloid angiopathy.

Additional contributors: Dr. R. Bouguelaa, MD, Dr. C. Boukaaba, MD.

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