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Large Frontal Meningioma with Mass Effect and Increased Intracranial Pressure

Large Frontal Meningioma with Mass Effect and Increased Intracranial Pressure. Rabih Hage , MD Valérie Biousse , MD. 41-year-old man 3 month history of unusual headaches and progressive vision loss in both eyes ( visual acuity limited to light perception OD and 20/60 OS).

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Large Frontal Meningioma with Mass Effect and Increased Intracranial Pressure

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  1. Large Frontal Meningiomawith Mass Effect and IncreasedIntracranial Pressure Rabih Hage, MD Valérie Biousse, MD

  2. 41-year-old man • 3 monthhistory of unusualheadachesand progressive vision loss in botheyes(visualacuitylimitedto light perception OD and 20/60 OS)

  3. Goldmann Visual Field Lefteye Figure 1 In the right eye, therewas no response to the V4e. The visualfieldisseverelyconstricted in the lefteye.

  4. Fundus Photographs Right eye Lefteye Bilateraloptic nerve edema consistent withchronicpapilledema , withsecondaryopticatrophy in the right eye (the right optic nerve isalready pale) Figure 2

  5. Fundus Photographs Right eye Lefteye Water marks temporal to the swollen discs Figure 3

  6. T1-Weighted Brain MRI(withoutcontrast) Axial Sagittal Figure 4 Large intracranial mass (arrows) with mass effect on the right frontal lobe

  7. T1-Weighted Brain MRI(withoutcontrast) Figure 5 T1-isointense extra-axial mass with mass effect on the right frontal lobe

  8. T1-Weighted Brain MRI(withoutcontrast) Figure 6 The mass effectisresponsible for right-to-leftfalcineherniation

  9. T2-Spin Echo WeightedBrainMRI Figure 7 Areas of T2 hyperintensitywithin the mass (arrow) suggestnecrosis or cystic changes

  10. FLAIR Axial BrainMRI Figure 8 Severecerebraledema adjacent to the mass

  11. T1-Weighted Brain MRI(withcontrast) Axial Coronal Sagittal Figure 9 Homogeneousenhancementof the extracranialmass aftercontrast administration, consistent with a meningioma

  12. Final Diagnosis Large right frontal meningiomapresentingwithraisedintracranialpressure. The papilledemahad been unrecognized for a few weeks and the diagnosiswasonly made at the stage of secondaryopticatrophywithirreversible, severevisualloss.

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