Presentation
Long-standing headache with recently increased intensity, which disturbs his daily life.
Patient Data
There is a well-defined, extra-axial, altered signal intensity mass lesion, which involves the left frontoparietal and temporal lobes with a positive CSF cleft sign and evidence of displacement of the middle cerebral artery branches and adjacent veins medially. Prominent flow voids within the mass. Returning signals are isointense on T1-weighted, hyperintense on T2-weighted, and FLAIR images (as compared to white matter) with homogenous post-contrast enhancement. Marked surrounding vasogenic edema is seen as well.
Mass effects manifest as compression of the adjacent sulci, left basal ganglia, thalamus, left lateral ventricle, basal cistern, mid-brain, and mid-line shift towards the right (up to 16.0 mm).
The posterior fossa is within normal limits.
Case Discussion
Current MRI features are those of an extra-axial lesion most likely a meningioma. The main differential is that of a solitary fibrous tumor of the dura, although this is far less likely.
The patient has undergone surgery and pathologically confirmed that its meningothelial meningioma.
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