Large frontal meningioma with mass effect and increased intracranial pressure
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Large Frontal Meningioma with Mass Effect and Increased Intracranial Pressure. Rabih Hage , MD Valérie Biousse , MD. 41-year-old man 3 month history of unusual headaches and progressive vision loss in both eyes ( visual acuity limited to light perception OD and 20/60 OS).

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Large Frontal Meningioma with Mass Effect and Increased Intracranial Pressure

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Large frontal meningioma with mass effect and increased intracranial pressure

Large Frontal Meningiomawith Mass Effect and IncreasedIntracranial Pressure

Rabih Hage, MD

Valérie Biousse, MD


Large frontal meningioma with mass effect and increased intracranial pressure

  • 41-year-old man

  • 3 monthhistory of unusualheadachesand progressive vision loss in botheyes(visualacuitylimitedto light perception OD and 20/60 OS)


Goldmann visual field

Goldmann Visual Field

Lefteye

Figure 1

In the right eye, therewas no response to the V4e. The visualfieldisseverelyconstricted in the lefteye.


Fundus photographs

Fundus Photographs

Right eye

Lefteye

Bilateraloptic nerve edema consistent withchronicpapilledema , withsecondaryopticatrophy in the right eye (the right optic nerve isalready pale)

Figure 2


Fundus photographs1

Fundus Photographs

Right eye

Lefteye

Water marks temporal to the swollen discs

Figure 3


T1 weighted brain mri without contrast

T1-Weighted Brain MRI(withoutcontrast)

Axial

Sagittal

Figure 4

Large intracranial mass (arrows) with mass effect on the right frontal lobe


Large frontal meningioma with mass effect and increased intracranial pressure

T1-Weighted Brain MRI(withoutcontrast)

Figure 5

T1-isointense extra-axial mass with mass effect on the right frontal lobe


T1 weighted brain mri without contrast1

T1-Weighted Brain MRI(withoutcontrast)

Figure 6

The mass effectisresponsible for right-to-leftfalcineherniation


T2 spin echo weighted brain mri

T2-Spin Echo WeightedBrainMRI

Figure 7

Areas of T2 hyperintensitywithin the mass (arrow) suggestnecrosis or cystic changes


Flair axial brain mri

FLAIR Axial BrainMRI

Figure 8

Severecerebraledema adjacent to the mass


T1 weighted brain mri with contrast

T1-Weighted Brain MRI(withcontrast)

Axial

Coronal

Sagittal

Figure 9

Homogeneousenhancementof the extracranialmass aftercontrast administration, consistent with a meningioma


Final diagnosis

Final Diagnosis

Large right frontal meningiomapresentingwithraisedintracranialpressure.

The papilledemahad been unrecognized for a few weeks and the diagnosiswasonly made at the stage of secondaryopticatrophywithirreversible, severevisualloss.


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