Presentation
Chronic progressive headache, left progressive hemiplegia and blurred vision.
Patient Data
A lobulated well-defined space-occupying lesion is noted within in the posterior aspect of the right lateral ventricle, it is isointense on T1 and hyper-intense on T2, with homogeneous enhancement on post-contrast T1, and low ADC value
Significant surrounding vasogenic edema was noted on T2 and flair, associated with significant mass effects on the right thalamus and cerebral peduncle and causing obliteration of the 3rd ventricle and the frontal horn of the right ventricle and midline shift, dilatation of the temporal horns of the lateral ventricles is noted (more marked in the right).
CSF cleft sign and meniscus sign (CSF within the ventricle) are noted indicating extra-axial lesion (intraventricular in this case).
Case Discussion
Intraventricular meningiomas usually occur in the trigone in the posterior aspect of the lateral ventricles, the left lateral ventricle is more common, usually lobulated. The appearance on MRI is similar to meningiomas in other locations.
The diagnosis was confirmed by pathology (fibroblastic meningioma grade 1).
Thank to Dr. Ahmad Jihad Abdin, Chief of Staff, Al-Assad University Hospital.
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