Presentation
Female who started a diagnostic protocol due to nonspecific symptoms (headache, vomiting, seizures) that did not respond to conventional treatment.
Patient Data
Multiple extra-axial lesions superimposed on widespread irregular meningeal thickening particularly involving the falx cerebri and tentorium cerebelli. They are isointense to grey matter on T1, T2, and FLAIR, and have prominent enhancement following intravenous contrast. Some midline deviation towards the right, and some periventricular vasogenic edema.
In the left cerebellopontine angle, an ovoid lesion with isointense signal on T1, hyperintense on T2, and FLAIR sequences, with homogeneous enhancement but without diffusion restriction or susceptibility artifact enlarges the ipsilateral internal ear canal.
Conclusion:
- meningiomatosis
- probable left vestibular schwannoma.
Case Discussion
The patient has had two lesions resected at different times, both meningiomas (one a transitional meningioma and the other a fibrous meningioma).
Discussion:
The combination of meningiomatosis and a possible schwannoma raises the possibility of neurofibromatosis type 2, a rare genetic disorder predisposing to multiple benign tumors of the nervous system.
Meningiomatosis may mimic other pathological processes on MRI including other neoplastic and non-neoplastic causes of prominent pachymeningeal thickening.