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)

Goldmann Visual Field

In the right eye, there was no response to the V4e. The visual field is severely constricted in the left eye.

Left eye

Figure 1

Fundus Photographs

Right eye Left eye

Bilateral optic nerve edema consistent with chronic papilledema , with secondary optic atrophy in the right eye (the right optic nerve is already pale)

Figure 2

Fundus Photographs

Right eye Left eye

Water marks temporal to the swollen discs

Figure 3

T1-Weighted Brain MRI (without contrast)

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

Figure 4

Axial Sagittal

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

Figure 5

T1-Weighted Brain MRI (without contrast)

The mass effect is responsible for right-to-left falcine herniation

Figure 6

T1-Weighted Brain MRI (without contrast)

T2-Spin Echo Weighted Brain MRI

Areas of T2 hyperintensity within the mass (arrow) suggest necrosis or cystic changes

Figure 7

FLAIR Axial Brain MRI

Severe cerebral edema adjacent to the mass

Figure 8

T1-Weighted Brain MRI (with contrast)

Homogeneous enhancement of the extracranial mass after contrast administration, consistent with a meningioma

Figure 9

Axial Sagittal Coronal

Final Diagnosis

Large right frontal meningioma presenting with raised intracranial pressure. The papilledema had been unrecognized for a few weeks and the diagnosis was only made at the stage of secondary optic atrophy with irreversible, severe visual loss.