Sunday, June 21, 2009

Right Frontoparietal convexity meningioma

Case : 55 years old malay gentleman, withn newly diagnosed diabetes mellitus type 2 on T. Metformin 500mg bd, presented in November 2008 with progressive left sided bdy weakness since past few months and was bed-bound on presentation. CT scan and MRI brain revealed right frontoparietal convexity meningioma

CT scan on 28/11/08

Findings: There is a broad based hyperdense mass in the right parietal region measuring 7.2cm X 4.9cm (axial) with medial buckling of the grey-white matter suggesting extra-axial mass. - significant mass effect resulting in effacement of ipsilateral lateral ventricle with minimal contralateral lateral ventricular dilatation. Midline shift of 12mm to the left. - homogenous enhancement with a small area of calcification. - small area of adjacent pressure erosion. No adjacent hyperostosis. - adjacent subtle white matter odema in the right parietal lobe. No mass is seen elsewhere. Basal cisterns are not obliterated.
IMP: Extra-axial mass in the right parietal region with significant mass effect.
DD: Meningioma.

MRI on 15/1/2009


There is a supra-tentorial, extra-axial, right fronto parietal mass which is hypointense on T1W, hyperintense with some ares of hypointensity representing calcification on T2W images. It enhances with contrast. The mass measures 5.1 ( Trans) x 7.5 ( AP) x 5.6 ( CC). It displaces the midline by 1.3 cm and compresses the ipsilateral lateral ventricle. Meningeal tail sign positive.

IMP: Appearances consistent with right fronto-parietal convexity meningioma.

He was advised for surgery but not keen. He was readmitted a month later with one episode of generalised tonic clonic seizure. He was started on phenytoin. In May 2009, he presented with behavioural changes and has been very aggressive. During this admission, the surgery was consented.

power of the lefty side - 4/5

He underwent right frontoparietal craniotomy and tumour excision (Simpson's II) on 16/6/2009

Post-op he was extubated and recovered well.

Post-op CT scan on 17/6/2009

He was discharged well and planned for repeat MRI in 6 weeks.

1 comment:

Jannah Delfin said...

I appreciate all of the information that you have shared. Thank you for the hard work!