00:00 In this lecture we're going to talk about meningiomas. 00:03 The most common primary brain tumor that we see a really neat tumor and something that I want you to understand. 00:11 Let's start with a case. 00:13 40-year-old woman who presents with headache. 00:15 40-year-old woman presents with six months of progressive headache. 00:19 Now, new right-sided hemibody numbness and some mild weakness with gait stumbling over the past one month. 00:26 So this has been going on for a little while. 00:28 She was seen in a local emergency department where a CT of the head showed a left-convexity lesion. 00:35 And MRI the brain was requested and performed also showing a homogeneously enhancing left-convexity lesion. 00:43 Examination shows right-sided drift and pronation which is where the arm pronate, it turns and drifts down, indicating subtle right-sided and right arm weakness. 00:53 So what's the diagnosis? Well, how do we think about this case? There's a few key features that I want you to pick up on. 01:00 First, the onset of this process is slow. 01:03 This took six months to develop. 01:05 So whatever is occurring in the brain is developing slowly, and maybe a benign tumor. 01:11 The second is the right hemibody symptoms, which point to a left hemibrain or left-brain problem and that's where we're going to go looking. 01:20 And then last is imaging showed an extra-axial lesion, or something that is concerning for an extra-axial lesion in the left-convexity. 01:28 And we'll look more at that. 01:30 And here we see this patient's imaging. 01:33 So when we're looking at MRIs, this is a T1 post-contrast gadolinium enhanced contrast enhanced imaging. 01:40 The left side of the patient is actually on the right side things are opposite. So this is a left-convexity lesion. 01:46 And we see it's homogeneously enhancing. 01:48 It's white all the way through it. 01:50 Actually, it with some of that contrast extending out on either side of this lesion. 01:56 So what's the diagnosis? Is this a brain metastasis, meningioma, pituitary adenoma, glioma, or vestibular schwannoma? What doesn't look like a brain metastasis, we can see dural metastasis, but this patient has no known cancer, and this has been going on for a while without concern for growth pattern that would suggest a brain metastasis. 02:19 It's not in the right location for a pituitary adenoma, which occurs in the sella turcica, that midline structure in the middle of the brain. 02:27 This is not typical for what we see with gliomas. 02:31 Glial tumors and glial cells, glial tumors arise from the brain parenchyma. 02:35 This looks on the outside of the brain, on the covering around the brain. 02:39 This is nowhere near that vestibulocochlear nerve, so we don't think that this is a vestibular schwannoma, which typically presents with hearing loss. 02:47 So this is a classic presentation for a meningioma. 02:51 Typically a benign slow-growing tumor that's located in the cerebral convexity.
The lecture Case: 40-year-old Woman with Headache by Roy Strowd, MD is from the course CNS Tumors.
Which of the following lesions would suggest a diagnosis of meningioma?
Which of the following brain tumors arises from the sella turcica?
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