Recognition of an Intracranial Meningioma in a Woman With Worsening Headache Presenting to a Chiropractor: A Case Report.

Meningiomas are the most common primary intracranial tumors in adults. They are typically slow-growing and often present with nonspecific symptoms such as headache and neck pain, which may overlap with common musculoskeletal complaints encountered in chiropractic practice. A 41-year-old woman presented to a chiropractor with a two-year history of worsening neck pain, headaches, upper extremity paresthesia, and subjective balance disturbance. Examination revealed hyperreflexia and bilateral Hoffman's reflexes. Given these upper motor neuron lesion signs, the chiropractor ordered cervical spine radiographs, which were normal, followed by magnetic resonance imaging, which revealed a large posterior fossa mass consistent with a meningioma. The patient was referred for neurosurgical management, underwent successful surgical resection, and was scheduled for adjuvant radiation therapy. This case illustrates how patients with serious intracranial pathology may present to a chiropractor in cases where symptoms appear musculoskeletal. Considering meningiomas are slow-growing, their clinical signs may be subtle. Careful neurological examination and recognition of red flags, even when radiographs are normal, are critical for timely referral and diagnosis.