Presentation
Epilepsy.
Patient Data
Large left frontal parasagittal solid-cystic mass. The solid component is of extra-dural location with a broad-based dural attachment to the falx cerebri and frontal convexity, measuring 48 x 36 x 34 mm and, eliciting an isosignal to the cortical grey matter on T1 iso-to low signal on T2 and FLAIR with an area of low signal (probably calcification) and vivid homogeneous enhancement on post-contrast sequences with a dural tail sign. The inner table of the skull is eroded well-visualized on post-contrast axial and sagittal T1 sequences with no apparent extension to the adjacent segment of the superior sagittal sinus.
The cystic component is located within the brain and measures 64 x 53 x 43 mm of low signal on T1 and FLAIR and high signal T2 with no restricted diffusion or peripheral enhancement on post-contrast sequences. Surrounding vasogenic edema with a mass effect on the midline structures and subfalcine herniation.
Small vessel ischemic change is noted.
Case Discussion
MRI features most consistent with a cystic meningioma, the cystic component is located within the brain (type 4 according to the classification of Nauta et al).
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