Journal Article Intraosseous Meningioma in a Woman Presenting with Seizure Mimicking Acute Multiple Cerebral Infarction: A Case Report

Shinichi, Okonogi  ,  Jun, Nomoto  ,  Kei, Uchino  ,  Sayaka, Terazono  ,  Yasuhiro, Node  ,  Shunpei, Ando  ,  Daisuke, Fukushima  ,  Hiroyuki, Masuda  ,  Kosuke, Kondo  ,  Naoyuki, Harada  ,  Masaaki, Nemoto  ,  Nobuo, Sugo

1 ( 4 )  , pp.73 - 79 , 2015-12 , The Medical Society of Toho University
Case Report
Intraosseous meningioma mainly develops in the cranial diploe. Incidence is very low ― fewer than 1% of meningioma cases. We evaluated and treated a patient with intraosseous meningioma that was difficult to diagnose on preoperative imaging because of the presence of multiple concomitant lesions. The patient was a 66-year-old woman who was transported to our hospital for treatment of seizure. Emergent diffusion-weighted magnetic resonance imaging (MRI) revealed hyperintense regions in the right mesial temporal lobe and thalamus. On computed tomography (CT), a tumorous lesion with osteosclerotic features was present in the left frontal bone. Contrast-enhanced MR images obtained on the 9th hospital day showed multiple brain parenchymal lesions, in addition to the skull lesion. A new enhanced lesion was present in the right cerebellar hemisphere and required differentiation from malignant lymphoma, metastatic brain tumor, and metastatic skull tumor. The tumor was resected on the 30th day, and the histopathological diagnosis was fibrous meningioma. MRI enhancement of the multiple lesions in brain parenchyma decreased after surgery. Thus, these findings were classified as changes in cerebral infarction over time. The difficulty in diagnosis may have been due to the coexistence of different diseases ― intraosseous meningioma and cerebral infarction ― temporal change in contrast medium enhancement of cerebral infarct lesions, and the presence of multiple lesions.

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