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