Neurology Case Conference 4

Matematico Matias Maulion Medenilla Medina, K. Medina, S.

Mejino

Clinical Impression

MENINGIOMA

Meningioma• Second most common primary tumor• 15% of all primary intracranial tumors• Mostly benign tumor• Origin: arachnoidal (meningothelial cap) cells– particular from the arachnoid villi

• Women:Men (2:1) • Peak Age Incidence: 60th & 70th decades • Vascular Endothelial Growth Factor– Highly vascular, prominent surrounding edema

Etiology of Meningioma

• Familial– Truncating mutations in the

neurofibromatosis 2 gene (merlin) on chromosome 22q

• Radiation Therapy • Previous Head Trauma• Estrogen and Progesterone receptors

WHO Classification of Meningioma

GRADE / INCIDENCE

HISTOLOGIC SUBTYPES

Benign Grade I (90%) Meningothelial (most common), Fibrous, Transitional, Psammomatous, Angioblastic (most aggressive)

Atypical Grade II (7%) Choroid, Clear Cell, AtypicalAnaplastic / Malignant

Grade III(2%) Papillary, Rhabdoid, Anaplastic

Histological Classification of Meningioma

HISTOLOGICAL LABEL

FEATURES

Fibroblastic Narrow, long cells in sheets; less commonly, Whorls, Psammoma Bodies

Syncytial Meningiothelial cells, Whorls, Psammoma Bodies

Transitional Features of both Fibroblastic and SyncytialAngioblastic Intertwined, Complex, Thickened Blood

Vessels, Reticulin Background, seldom contain Whorls, Psammoma Bodies

Clinical Manifestations of Meningioma

• Asymptomatic, Incidental finding• Irritation of the underlying cortex Seizures• Compression of the brain Localized or Non-specific

headaches, Focal or Generalized Cerebral Dysfunction• Compression of the cranial nerves Focal Neurologic

Deficits• Erosion, Invasion or Hyperostosis of Cranial bones • Narrowing, Occlusion of important cerebral arteries

Transient ischemic attack (TIA)–like episodes or as stroke

Sites of Meningioma

Sites & Presentations of Meningioma 90% Intracranial 10% Intraspinal

Parasagittal/Parafalcine

Urinary Incontinence, Demetia, Gradual Paraparesis, Seizures

Tentorial May protrude within supratentorial and infratentorial compartments, producing symptoms by compressing specific structures within these 2 compartments

Lateral Convexity

Variable depending on structures compressed, including Slow Hemiparesis, Speech Abnormalities

Olfactory Groove

Anosmia, Visual Disturbances, Dementia, Foster-Kennedy Syndrome

Sphenoid Ridge

Extraocular Nerve Paresis, Exostoses, Proptosis, Seizures

Sites & Presentations of Meningioma

Foramen magnum

Paraparesis, sphincteric troubles, tongue atrophy associated with fasciculation

Cerebello-pontine angle

Decreased hearing with possible facial weakness and facial numbness

Spinal cord Localized spinal pain, Brown-Sequard (hemispinal cord) syndrome

Cavernous sinus

Multiple cranial nerve deficits (II, III, IV, V, VI), leading to decreased vision and diplopia with associated facial numbness

Subfrontal Change in mentation, apathy or disinhibited behavior, urinary incontinence

Suprasellar Hormonal Failure, Bitemporal Hemiapnosia, Optic Atrophy

Patient Correlation

NING, PWEDE PO PAINSERT NG SALIENT FEATURES DITO…

Human Homonculus

Patient Correlation

MENINGIOMA• Parasagittal/Falcotentorial

Meningioma