1. MedPix Medical Image Database COW - Case of the Week Case Contributor: Adam Fang Affiliation: - Leave Blank -

2. MedPix No: 13271 - History Pt Demographics: Age = 31 y.o. Gender = woman 31 yo woman with headaches for the past several months and several episodes of right arm weaknessROS: Negative Past Medical History: Asthma and Hypertension Allergies: NKDAFamily History: Breast Cancer Downloaded by (-1)

3. MedPix No: 13271 - EXAM & LABS General: No acute distressSkin: No rashesHEENT: MMM, anicteric. alopeciaNeck: Supple, no LADChest: Clear to auscultation bilaterallyHeart: RRR without murmurs/rubs/gallopsAbd: Soft, nontender, nondistended, no HSM,Extr: 5/5 muscle strength bilaterally in upper and lower extremities.GU No massesNeuro: CN II-XII intact, 2+ DTR, non focal

4. Meningioma Non-enhancing meningioma located along the left posterior frontal parasagittal convexity that measures approximately 1.7 x 1.8 x 2 cm. The lesion has a broad-based attachment to the overlying left posterior frontal dura and abuts the interhemispheric falx medially. Downloaded by (-1)

5. Meningioma Homogeneously intensely enhancing meningioma located along the left posterior frontal parasagittal convexity that measures approximately 1.7 x 1.8 x 2 cm. The lesion has a broad- based attachment to the overlying left posterior frontal dura and abuts the interhemispheric falx medially. Downloaded by (-1)

6. Meningioma Homogeneously intensely enhancing meningioma located along the left posterior frontal parasagittal convexity. that measures approximately 1.7 x 1.8 x 2 cm. The lesion has a broad- based attachment to the overlying left posterior frontal dura and abuts the interhemispheric falx medially. There is no significant surrounding edema or significant mass-effect. Downloaded by (-1)

7. Meningioma Homogeneously intermediate meningioma located along the left posterior frontal parasagittal convexity. Downloaded by (-1)

8. Meningioma Homogeneously high signal meningioma on FLAIR located along the left posterior frontal parasagittal convexity. Downloaded by (-1)

9. FINDINGS MRI of the brain with contrast demonstrates a 2-cm left posterior frontal parasagittal meningioma. The lesion demonstrates diffuse enhancement and no significant surrounding edema.

10. DIFFERENTIAL DIAGNOSIS What is your Differential Diagnosis? Lymphoma - Metastatic carcinoma - Inflammatory lesions (ex: sarcoidosis & Wegener*s granulomatosis) - Meningioma - Infections (ex: TB) -

11. Diagnosis: Meningioma Dx Confirmed by: Imaging was characteristics for a meningioma

12. DISCUSSION The patient received stereotactic radiosurgery with gamma knife for parafalcine meningioma. She continues to have some headaches, which may or may not be related to this lesion, as they antedated its diagnosis by more than a year. The headaches are largely unchanged. She has no other neurologic symptoms.