Presentation
First seizure with a suspected organic cause.
Patient Data
Two intracranial mass lesions are identified which demonstrate relatively homogenous post-contrast enhancement identified including:
- large left frontal extra-axial mass with associated vasogenic edema within the left frontal lobe with associated mass effect. Small punctate foci of calcifications and mild irregularity of the overlying inner table of the left frontal bone are noted.
- lobulated sella mass, which does not appear to exert any mass effect upon the optic chiasm or cavernous sinus within the limits of CT
MRI confirms the two intracranial mass lesions identified on the presenting CT including:
- large left frontal extra-axial mass, which is T1 hypointense, T2/FLAIR hyperintense, mild diffusion restriction, near-homogenous vivid post-contrast enhancement, and no susceptibility artifact. Increased T2/FLAIR signal within the left frontal lobe, presumably represents vasogenic edema
- sella mass, which is T1 isointense, T2/FLAIR hyperintense, mild diffusion restriction, near-homogenous vivid post-contrast enhancement. No normal pituitary is identified. the pituitary stalk deviates to the right, however, appears morphologically normal. The lesion abuts the optic chiasm and cavernous sinuses without significant compression or invasion. The ICA flow voids are preserved
No further lesions were identified on MRI.
Case Discussion
Coexisting atypical meningioma with pituitary macroadenoma.
Edema and mild mass effect associated with the left frontal meningioma likely caused the patient's seizure and presentation to the emergency department. The pituitary macroadenoma was almost certainly an incidental finding in this patient.
Multiple, primary brain tumors with different histological types occurring in the same patient are considered rare in the absence of prior radiation and phakomatoses 1. They usually have a female rather than a male predominance 1.
This male patient had no known prior radiation or phakomatoses.
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