Angiomatous Meningioma Presenting with Depression: A Case Report and Literature Review

Abstract

Meningiomas are classified into three types according to the World Health Organization classification system which is based on morphologic criteria. Type 1 is the benign variant, in which meningothelial is the most common subtype. Angiomatous also belongs to the same subtype but comprises only 2.1% of all meningiomas. Although most meningiomas are asymptomatic, some may present with varying symptoms ranging from seizures to focal deficits. Often, large meningiomas can also manifest as neuropsychiatric symptoms ranging from depression to overt psychosis. Here, in this case, we have further elaborated the importance of the organic cause of psychiatric symptoms as our patient initially presented with symptoms of depression. Regarding the diagnosis of meningiomas, nowadays excellent neuro-imaging methods are available, however, histological examination and immunohistochemistry remain the gold standard tools for a definite diagnosis. In our patient, the histological examination showed well-formed sinusoids and vascular channels which were consistent with the diagnosis of an angiomatous variant. Gross total resection of the lesion remains the treatment of choice with radiation therapy being used for residual tumors postoperatively. Being a type 1 variant, these meningiomas have a very small risk of recurrence. Here, we have presented a rare variant of meningioma initially presenting with prominent psychiatric symptoms of depression advancing to focal deficits.

Preoperative Transarterial Embolization of a Large Petrotentorial Angiomatous Meningioma Using Combination of Liquid Embolic Materials: A Case Report

“…2,4 It is recommended that cerebral angiography should be performed before surgery to identify definite arterial feeders and preoperative embolization should be done for reduction in the risk of major bleeding during surgical resection, especially in angiomatous meningiomas located at the skull base. 3,5 Over the years, polyvinyl alcohol (PVA) particles and NBCA have frequently been used as embolic agents for preoperative embolization of extra-and intracranial tumors, including meningioma. 6 Currently, an ethylene-vinyl alcohol (EVOH) copolymer-based liquid embolic agent has been developed for meningioma embolization due to slow polymerization and nonadhesive properties providing a reduced risk of microcatheter entrapment than NBCA and prolonged embolization time during the embolization resulting in more controlled injection of the agent.…”

“… 2 4 It is recommended that cerebral angiography should be performed before surgery to identify definite arterial feeders and preoperative embolization should be done for reduction in the risk of major bleeding during surgical resection, especially in angiomatous meningiomas located at the skull base. 3 5 …”

“…Magnetic resonance angiography showed hypervascularity in the tumor (►Fig. 3). Based on aggressive features on imaging findings, we made a preoperative diagnosis of hemangiopericytoma.…”

“…2 Clinically, angiomatous meningiomas most commonly manifest as seizures and neurological deficits depending on the location of the tumor and mass effect. 3,4 Due to its extremely rich blood supply, surgical resection of angiomatous meningiomas is more difficult than resection of other types of meningiomas. Preoperative embolization may be useful for the treatment of this type of meningioma.…”

Sudden Death with Dual Organ Pathologies–An Autopsy -based Case Report

“…Coronary artery diseases (CAD), valvular heart diseases, cardiomyopathy syndromes, infiltrative diseases of the myocardium, myocarditis, infective endocarditis, hereditary ion channel abnormalities, and congenital heart illnesses are some of the underlying cardiac causes of SCD.CAD is responsible for 80 percent of SCD cases, cardiomyopathies for 10-15 percent, and hereditary heart abnormalities such as coronary artery abnormalities or cardiac channelopathies for 5-10 percent of SCD cases 3 . In people over the age of 35, coronary atherosclerosis is the most common cause of SCD.Meningiomas are primary central nervous system tumours that account for 15 to 18 percent of intracranial tumours and 33% of all incidental neoplasms in adults 4 .The Angiomatous meningiomas are an uncommon (2.1 percent) kind of meningioma identified by the World Health Organization (WHO) based on morphology.Although they appear aggressive, these are benign in nature, and the meningiothelial type 1 variety is the most frequent 5 . Main differential is hemangiopericytoma, which also goes by the label "angioblastic meningioma."…”