Meningiomas of the parieto-occipital convexity mimicking a hematoma: A case report in a third-world country.

Abstract

Background: Meningiomas are benign, slow-growing tumors of the central nervous system (CNS) that arise from the arachnoid matter. It comprises one of the most common primary tumors of the CNS, occurring mostly in and after the fifth decade of life with a female gender predilection. Diagnosis is facilitated by imaging computed tomography (CT) or magnetic resonance imaging (MRI); however, atypical forms exist which augments the risk of missing the diagnosis. This is a case of a meningioma that mimics a hematoma on imaging, the diagnosis of which was only confirmed following histopathology.

Case description: A 36-year-old patient presented with a 9-month history of intermittent moderate-intensity headaches associated with photophobia, tinnitus, and dizziness. There was no previous history of trauma. There were no focal neurological deficits on examination. Both contrast-enhanced and noncontrast-enhanced brain CT scans showed features suggestive of an intraparenchymal hematoma. She had a control CT scan 2 months and 9 months later due to the persistence of symptoms despite remaining stationary, which revealed no changes in the lesion as seen in the previous CT scans. The patient did not benefit from an MRI scan due to the socioeconomic status of the country and the patient herself. A decision to operate was made, and the sample was sent for histopathology. Histopathology confirmed the lesion to be a psammomatous meningioma.

Conclusion: Although CT findings of meningiomas are quite often typical, it is important to note that atypical forms exist as well. Knowledge of the atypical forms, such as lesions that look like an intraparenchymal hemorrhage initially but remain unchanged over a period of time, would decrease the risk of missing the diagnosis in such instances.