Presentation
Refractory headaches for one month and progressive left hemiparesis. History of right renal mass.
Patient Data
Axial T2 shows a right parietal complex cystic lesion with peripheral dural based isointense nodule devoid of flow voids. Gadolinium-enhanced Axial and coronal T1 show homogeneously enhancing nodule with subtle dural tail and associated cyst. Axial FLAIR shows mild perifocal vasogenic edema and mass effect.
Case Discussion
This is a case of a rare type of meningioma known as cystic meningioma having an incidence of 4~7% among all meningiomas 2 that presented with a coexisting right renal mass suggesting a diagnosis of metastatic renal cell carcinoma, hemangioblastoma (in the context of Von-Hippel Lindau Disease) or high-grade glioma, however, histopathology confirmed this to be a WHO Grade II Meningioma.
Cystic meningioma should be kept high on the list of differentials for cystic brain lesions with enhancing nodules. MRI is the optimal pre-op investigation that demonstrates an extra-axial lesion with enhancement of solid component 1.
*Case courtesy of Dr. Desmond A. Brown MD and Dr. Terry C. Burns MD.
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