Chronic headache not responding to analgesics. with no neurological symptoms.
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A fairly well defined, lobulated, extra-axial, solid looking, mixed signal intensity, mass is seen in the left parietal lobe. It appears iso intense on T1, slightly hyper intense on T2 and FLAIR sequences. Signal void internal foci are also seen on all sequences. It shows avid enhancement on post contrast T1 images. Few internal non enhancing foci are also seen. Mass is abutting the overlying inner table of skull. peri-lesional CSF intensity uniform margin is seen likely representing CSF cleft. Buckling of the overlying grey matter is also noted. The lesion is causing mass effect, compressing the adjacent brain parenchyma, ipsilateral ventricle and mild contra lateral mid line shift.
Meningioma is the most common extra-axial benign brain tumor. It is more common in females than males. Meningioma has both typical and atypical features. The diagnosis of typical meningioma is easier than atypical. Major differential diagnoses for atypical meningioma are hemangiopericytoma, metastasis and glioma.
In this case the first differential was meningioma with possible differential of hemangiopericytoma.