Presentation
Patient came for a follow up study after not opting for surgery, reluctant to take any intravenous contrast
Patient Data
A 3.1 x 6.5 x 6.0 cm (TR x AP x CC) extra-axial solid dural-based lesion is seen along left temporofrontal convexity causing moderate vasogenic edema in perisylvian cortex. No cortical infiltration. Lesion is isointense to grey matter in all pulse sequences with diffusion restriction. Areas of blooming on gradient imaging, likely calcification. Hyperostosis of underlying calvaria. 5 mm midline shift to right. Ipsilateral lateral ventricle mild compression. Normal rest of supratentorial neuroparenchyma. No transtentorial herniation. MRS reveals significant rise in choline with an elevated lactate peak. Reduced NAA.
Case Discussion
This case defines some of the classic signs of an extra-axial mass lesion, in this case a meningioma, including: cleft of CSF seen all around the lesion, obvious dural base from which the mass arises, acute angles against the brain parenchyma.
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