Pseudotumor cerebri comorbid with meningioma: A review and case series

Abstract

Background:Pseudotumor cerebri (PTC), which has a prevalence in the general population of 1 to 2 out of 100,000, presents with raised intracranial pressure (ICP) but generally lacks a space occupying lesion.Case Description:Patient 1 is a 32-year-old woman with a history of multiple meningiomas. Upon presentation to our institution, her clinical exam was notable for a right sixth nerve palsy. An integrated diagnosis of PTC was made and shunting for the cerebrospinal fluid (CSF) diversion was recommended. Approximately 6 weeks after surgery, the patient exhibited complete symptom resolution and discontinued all medications. Patient 2 is a 40-year-old woman with history of meningioma causing partial obstruction of the right transverse sigmoid sinus. She agreed to undergo surgery for the left ventriculoperitoneal (VP) shunt placement, for management of her PTC. Postoperatively, the patient reported that her vision significantly improved. Patient 3 is a 49-year-old woman with history of meningioma who presented with left visual field cut. A right frontal VP shunt was recommended for the treatment of PTC. Postoperatively, the patient reported significant symptom improvement and resolution of visual complaints.Conclusion:This case series demonstrates that it is important to keep PTC in the differential diagnosis even when mass lesions such as meningiomas are discovered. Although PTC, as the name indicates, is classically diagnosed in patients without intracranial tumors, it is critical that this not be used as an absolute exclusion criterion. Finally, this case series supports the hypothesis that venous obstruction can result in PTC.

Concomitant Idiopathic Intracranial Hypertension, Normal Pressure Hydrocephalus, and Pleomorphic Xanthoastrocytoma: A Case Report and Review of the Literature

“…However, there have been a few cases that reported associations of NPH or IIH with a space-occupying lesion ( Table 1 ). There was one case series of two patients who presented with symptomatic NPH as an unusual presentation of a supratentorial extra ventricular space-occupying lesion [ 4 ]. The first patient was a fifty-eight-year-old female who had marked dementia associated with gait difficulties and urinary incontinence.…”

“…Partial resection was done, and the histopathological diagnosis demonstrated a glioblastoma (WHO grade IV). However, due to the tumor progression, the patient died after three months [ 4 ]. Another case series has described three patients with the diagnosis of meningioma associated with an IIH.…”

“…It is characterized by an abnormal elevation of intracranial pressure without a known cause [ 3 ]. Symptoms range between headaches, transient visual loss, pulsatile tinnitus, and ocular pain [ 4 , 5 ]. Both IIH and NPH usually lack an association with space-occupying lesions [ 4 ].…”

“…Symptoms range between headaches, transient visual loss, pulsatile tinnitus, and ocular pain [ 4 , 5 ]. Both IIH and NPH usually lack an association with space-occupying lesions [ 4 ]. We report a rare case of a patient presenting with signs and symptoms of IIH and NPH, with an incidental finding of a right frontal PXA.…”

Superior Sagittal Sinus: A Review of the History, Surgical Considerations, and Pathology

“…Additionally, secondary conditions or comorbidities related to pathologic involvement of the SSS are also important, including septic dural sinus thrombosis and an array of thrombophilias. Intracranial hypertension, pseudotumor cerebri, and sinus pericranii (abnormal connections between the intracranial and extracranial venous systems), are among associated conditions that may also affect this structure [19][20][21][22].…”