Presentation
New-onset seizure
Patient Data
Initial axial CT demonstrates a gyriform cortical and subcortical intrinsically hyperdense lesion along the deep margin of the left Sylvian fissure with adjacent punctate calcifications and without observable mass effect. Sagittal CT reformation highlights the serpentine nature of this lesion.
Follow-up MR study demonstrates a gyriform T2 hypointense lesion, with minimal subcortical T2 hyperintense signal, though without significant surrounding edema or mass effect (axial T2 FSE) with associated susceptibility blooming signal due to the inherent mineralization (axial SWI). Post-contrast T1 weighted sequences demonstrate slight discontinuous gyriform enhancement within the lesion (post-contrast axial and sagittal T1).
Case Discussion
Meningioangiomatosis classically presents on CT as a unifocal gyriform cortical/subcortical hyperdense lesion with adjacent punctate calcifications. On subsequent MRI it has a typical gyriform T2 hypointense signal with minimal T2/FLAIR hyperintense signal.
The differential diagnosis here is broad and includes: meningioma, Sturge-Weber syndrome, dysembryoplastic neuroepithelial tumor (DNET) and oligodendrglioma.
Co Authors: Patrick Janeczko, Daniel Ratanski, Cameron Shaw, David J. Monoky MD
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