50 years old female presented with headache and fixed dilated pupils.
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Differential consideration for intraventricular mass can often be narrowed by age and location of the lesion. Intraventricular meningioma typically occurs in adults and in the atrium of the lateral ventricle more commonly on the left. MR signals are often isointense to brain parenchyma with homogenous enhencement pattern. Rarely meningioma demonstrate restricted diffusion which reflect hypercellularity of the tumor. Intraventricular meningioma have a tendency to reach large size before presentation. Complication include obstructive hydrocephalus and regional mass effect with ipsilateral midbrain compression and uncal herniation. A diligent radiologist will always assess the fiber tracts below the level of compression or lesion to look for signs of tract oedema or Wallerian degeneration which can otherwise be overlooked.