Presentation
Resident of a rural livestock area in Peru. Presents with a 1-year illness, characterized by headache. Seizures have been added for 1 month.
Patient Data
Age: 45 years
Gender: Male
From the case:
Typical meningioma
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Not contrast CT:
- multiple nodules of calcium density scattered diffusely in the subarachnoid space
- vasogenic edema distributed in right frontal white matter
- deviation from the midline conditioned by the mass effect of edema and produces subfalcine herniation
- soft tissue mass, attached to the cranial calvaria and the falx cerebri
Bone window:
- at the level of the mass, thickening of the bone cortex of the internal table is observed, with respect to the contralateral finding in relation to hyperostosis
- vascular markings in the cortex of the internal table
- parenchymal calcifications
Contrast CT:
- homogeneous enhancement marking throughout the mass
- juxtadural origin of the mass is confirmed, with the presence of displacement of the meningeal and cerebral cortical vessels
- subfalcine herniation is confirmed, showing the pericallosal artery markedly displaced to the right
MIP
- the meningeal vascular component that nourishes and drains the mass is appreciated
Case Discussion
We have the overlap of three main findings:
- presence of a mass in the right frontal region, of juxtadural origin; the internal table of the skull where it is attached shows hyperostosis; its vascular component arising from the meninges is appreciated; its enhancement is homogeneous. Features are compatible with a typical meningioma.
- the presence of subfalcina herniation, product of the mass effect and the edema of the meningioma
- multiple calcifications in the subarachnoid space, associated with the epidemiological history of the patient from which we can infer that the lesions are sequelae in relation to old neurocysticercosis.
The patient underwent surgery, which proceeded without incident; The surgical specimen was evaluated in the pathology department; who confirm:
- meningothelial meningioma (WHO grade I)
- calcified neurocysticercosis
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