Presentation
Left trigeminal neuralgia with mild ipsilateral proptosis in a patient known for right breast cancer on follow-up.
Patient Data
Dural thickening with enhancement of the anterior aspect of the left middle cranial fossa extending to the inferolateral extraconal space with swelling and enhancement of the medial rectus muscle as well as the temporal muscle and masticator space. Erosion and cortical irregularity of the ipsilateral greater sphenoid wing with loss of its normal fatty signal.
Multiple vertebral lesions of low signal on T1 and T2, with no suppression on STIR sequence seen throughout the spine mainly at C4, C6, C7, T1, T5 to T7, T12 to S1.
Case Discussion
MRI features of a dural-based enhancing lesion along the greater sphenoid wing extending to the adjacent structures with multiple vertebral lesions in a patient known for breast cancer are highly suggestive of metastases.
A chest and abdominopelvic CT was performed (not shown) demonstrated lung and hepatic metastases.
On imaging, the main differential diagnosis of the left dural-based enhancing lesion is en plaque meningioma arising from dura overlying the greater wing of sphenoid (usually with expanded greater wing of the sphenoid bone in a patient not known for cancer).
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