J Korean Neurosurg Soc.  2014 Feb;55(2):99-102. 10.3340/jkns.2014.55.2.99.

Sphenoid Ridge Meningioma Presenting as Acute Cerebral Infarction

• Ko JK
• Cha SH
• Choi CH

• KMID: 2191054
• DOI: http://doi.org/10.3340/jkns.2014.55.2.99

Abstract

A previously healthy 52-year-old man presented to the emergency room with acute onset left hemiparesis and dysarthria. Brain computed tomography and magnetic resonance examinations revealed acute cerebral infarction in the right middle cerebral artery territory and a sphenoid ridge meningioma encasing the right carotid artery terminus. Cerebral angiography demonstrated complete occlusion of the right proximal M1 portion. A computed tomography perfusion study showed a wide area of perfusion-diffusion mismatch. Over the ensuing 48 hours, left sided weakness deteriorated despite medical treatment. Emergency extracranial-intracranial bypass was performed using a double-barrel technique, leaving the tumor as it was, and subsequently his neurological function was improved dramatically. We present a rare case of sphenoid ridge meningioma causing acute cerebral infarction as a result of middle cerebral artery compression.

Keyword

Acute cerebral infarction; Meningioma; Middle cerebral artery; Occlusion

MeSH Terms

Brain
Carotid Arteries
Cerebral Angiography
Cerebral Infarction*
Dysarthria
Emergencies
Emergency Service, Hospital
Humans
Meningioma*
Middle Aged
Middle Cerebral Artery
Paresis
Perfusion

Figure

• 

  Fig. 1 A and B: Coronal and axial T1 weighted magnetic resonance images with gadolinium enhancement showing a meningioma encasing the internal carotid artery within the right cavernous sinus. C: Magnetic resonance angiogram showing complete occlusion of the right internal carotid artery terminus. D and E: Axial diffusion-weighted magnetic resonance imaging confirmed acute cerebral infarction in the right middle cerebral artery (MCA) territory, including the right uncus, insula, medial occipitotemporal gyrus, basal ganglia, corona radiate, and precentral gyrus. F and G: Cerebral angiograph with right internal carotid artery injection demonstrating complete occlusion of the right proximal M1 portion and radiographic blush from the surrounding meningioma with no significant collateral flow to the right MCA territory. H: Initial computed tomography perfusion scan showing significant asymmetry between the right and left hemispheres with striking hypoperfusion of the right MCA territory.

• 

  Fig. 2 A: Comparably selected axial diffusion-weighted magnetic resonance imaging obtained on Day 2 after presentation demonstrate increasing area of the diffusion weighted abnormality matching the patient's symptomatic clinical progression. Post-operative images, lateral (B) and anterior-posterior (C) view of the right external carotid angiogram showing abundant filling of multiple branches of the middle cerebral artery by patent bypasses (arrows) via the right superficial temporal artery. D: A computed tomographic perfusion scan obtained two weeks later showed shortened time to peak, indicating obviously improved cerebral blood flow after double-barrel bypass.

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