Case: 40-year-old Woman with Headache

00:00 In this lecture we're going to talk about meningiomas.

00:03 The most common primary brain tumor that we see a really neat tumor and something that I want you to understand.

00:11 Let's start with a case.

00:13 40-year-old woman who presents with headache.

00:15 40-year-old woman presents with six months of progressive headache.

00:19 Now, new right-sided hemibody numbness and some mild weakness with gait stumbling over the past one month.

00:26 So this has been going on for a little while.

00:28 She was seen in a local emergency department where a CT of the head showed a left-convexity lesion.

00:35 And MRI the brain was requested and performed also showing a homogeneously enhancing left-convexity lesion.

00:43 Examination shows right-sided drift and pronation which is where the arm pronate, it turns and drifts down, indicating subtle right-sided and right arm weakness.

00:53 So what's the diagnosis? Well, how do we think about this case? There's a few key features that I want you to pick up on.

01:00 First, the onset of this process is slow.

01:03 This took six months to develop.

01:05 So whatever is occurring in the brain is developing slowly, and maybe a benign tumor.

01:11 The second is the right hemibody symptoms, which point to a left hemibrain or left-brain problem and that's where we're going to go looking.

01:20 And then last is imaging showed an extra-axial lesion, or something that is concerning for an extra-axial lesion in the left-convexity.

01:28 And we'll look more at that.

01:30 And here we see this patient's imaging.

01:33 So when we're looking at MRIs, this is a T1 post-contrast gadolinium enhanced contrast enhanced imaging.

01:40 The left side of the patient is actually on the right side things are opposite. So this is a left-convexity lesion.

01:46 And we see it's homogeneously enhancing.

01:48 It's white all the way through it.

01:50 Actually, it with some of that contrast extending out on either side of this lesion.

01:56 So what's the diagnosis? Is this a brain metastasis, meningioma, pituitary adenoma, glioma, or vestibular schwannoma? What doesn't look like a brain metastasis, we can see dural metastasis, but this patient has no known cancer, and this has been going on for a while without concern for growth pattern that would suggest a brain metastasis.

02:19 It's not in the right location for a pituitary adenoma, which occurs in the sella turcica, that midline structure in the middle of the brain.

02:27 This is not typical for what we see with gliomas.

02:31 Glial tumors and glial cells, glial tumors arise from the brain parenchyma.

02:35 This looks on the outside of the brain, on the covering around the brain.

02:39 This is nowhere near that vestibulocochlear nerve, so we don't think that this is a vestibular schwannoma, which typically presents with hearing loss.

02:47 So this is a classic presentation for a meningioma.

02:51 Typically a benign slow-growing tumor that's located in the cerebral convexity.