Paraparetic patient with onset of worsening two months ago. Operated twice because of intracranial and spinal meningioma years ago.
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There is an extra-axial interhemispheric expansive lesion frontally 4 mm in the biggest diameter. It is hyperintense in T2W and FLAIR, iso to hypointense in T1W, calcified (T2*) with intensive, homogeneous postcontrast signal intensity enhancement.
There are also old lacunar ischemic lesions.
The patient underwent parietal craniotomy for meningioma (fibrous meningioma) seventeen years ago. She had tree seizure attacks afterwards, an aphasia and mild pyramidal deficiency on the right side, with a full regression on therapy.
Five years after that she developed flaccid paraparesis, thoracal spine MRI showed extramedullary, intradural lesion on the Th1-Th2 level. She underwent an inter hemilaminectomy and tumor excision (psammomatous meningioma).
Since then she is able to walk but only with the help of the walker. Two months ago her condition started to worsen. She is examined by the neurologist and he sent her for the brain MRI.
The small extra-axial falcine lesion probably represents a further meningioma.