Large Frontal Meningioma with Mass Effect and Increased Intracranial Pressure
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Transcript of Large Frontal Meningioma with Mass Effect and Increased Intracranial Pressure
Large Frontal Meningioma with Mass Effect and Increased
Intracranial Pressure
Rabih Hage, MD Valérie Biousse, MD
• 41-year-old man • 3 month history of unusual headaches and
progressive vision loss in both eyes (visual acuity limited to light perception OD and 20/60 OS)
Goldmann Visual Field
In the right eye, there was no response to the V4e. The visual field is severely constricted in the left eye.
Left eye
Figure 1
Fundus Photographs
Right eye Left eye
Bilateral optic nerve edema consistent with chronic papilledema , with secondary optic atrophy in the right eye (the right optic nerve is already pale)
Figure 2
Fundus Photographs
Right eye Left eye
Water marks temporal to the swollen discs
Figure 3
T1-Weighted Brain MRI (without contrast)
Large intracranial mass (arrows) with mass effect on the right frontal lobe
Figure 4
Axial Sagittal
T1-isointense extra-axial mass with mass effect on the right frontal lobe
Figure 5
T1-Weighted Brain MRI (without contrast)
The mass effect is responsible for right-to-left falcine herniation
Figure 6
T1-Weighted Brain MRI (without contrast)
T2-Spin Echo Weighted Brain MRI
Areas of T2 hyperintensity within the mass (arrow) suggest necrosis or cystic changes
Figure 7
FLAIR Axial Brain MRI
Severe cerebral edema adjacent to the mass
Figure 8
T1-Weighted Brain MRI (with contrast)
Homogeneous enhancement of the extracranial mass after contrast administration, consistent with a meningioma
Figure 9
Axial Sagittal Coronal
Final Diagnosis
Large right frontal meningioma presenting with raised intracranial pressure. The papilledema had been unrecognized for a few weeks and the diagnosis was only made at the stage of secondary optic atrophy with irreversible, severe visual loss.