Creeping Through the Cranium: A Rare and Interesting Presentation of a Meningioma

Division

West Florida

Hospital

Regional Medical Center Bayonet Point

Document Type

Case Report

Publication Date

6-29-2024

Keywords

Cavernous sinus, Cerebellopontine angle, Meningioma

Disciplines

Internal Medicine | Medicine and Health Sciences | Neoplasms | Nervous System Diseases | Radiology

Abstract

A meningioma is a rare primary CNS tumor that tends to present more so in females in a slowly progressive fashion. The cavernous sinus and cerebellopontine angle are uncommon locations for meningiomas. We present a case of a meningioma in a 60-year-old female presenting to the emergency department for a sudden onset headache, vertigo, facial paresthesias, and chest pain. Inpatient workup revealed orthostatic hypotension, a meningioma spanning from the left cavernous sinus to the left cerebellopontine angle encasing the left cavernous internal carotid artery on MRI and CTA, and an incidental 12 mm calcified fibroadenoma on CT. Hospital course consisted of supportive treatment, physical rehabilitation, and review of previous imaging to determine need for intervention per consultants' recommendations. The patient was discharged with an antiplatelet, an antihistamine, appropriate additional medications, a vestibular therapy script, and outpatient referrals for a decision regarding surveillance and intervention. Overall, this case describes some key points. It demonstrates that cavernous sinus and cerebellopontine angle meningiomas can occur simultaneously, especially as a continuous mass, which very few cases have done so far. It also highlights an acute clinical presentation of a meningioma, contrary to the gradually progressive one observed in most instances. Last, but not least, it shows how nonspecific symptoms can lead to unique findings at times.

Publisher or Conference

Radiology Case Reports

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