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Meningioma is a common neoplasm in the CNS, and spinal meningioma represents 25% to 46% of primary intraspinal neoplasms.1,2⇓ Diffuse leptomeningeal enhancement is rarely associated with meningioma generally or spinal meningioma specifically. We describe a patient with lumbosacral meningioma and an unusual presentation of encephalopathy, cranial neuropathy, and diffuse intracranial leptomeningeal enhancement.
Case report.
A 39-year-old woman presented to us with headaches, bilateral hearing loss, blurry vision, cognitive decline, and malaise. She had a lumbosacral meningioma resected 6 years prior that presented with right lumbosacral radiculopathy. Three years later, a recurrence of thigh pain and radicular symptoms led to repeat lumbosacral surgery revealing arachnoiditis. One year before presenting to us, she began to experience chronic headaches. Simultaneously, her hearing declined and she was diagnosed with bilateral sensorineural hearing loss. She also developed blurry vision, poor concentration, and memory loss.
Lumbosacral spine imaging showed an enhancing mass from L4 to S2, consistent with residual or recurrent meningioma (figure, A). Brain MRI demonstrated thin uniform leptomeningeal enhancement of the basilar cisterns, cervicomedullary junction, cerebellar sulci, and internal auditory canals (figure, B). There were no intracranial masses. CSF had elevated protein …
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