[A case of atypical meningioma associated with acute deterioration and cerebral herniation].

Brain tumors not uncommonly display a chronic course, with symptoms occurring insidiously. This case report describes a meningioma patient who presented sudden onset and rapidly progressing symptoms. She was 49 years old, a referred case from a nearby hospital, with severe headache and fever. This was also accompanied by unconsciousness and left hermiparesis which necessitated emergency brain CT and MRI scanning. A right temporal 5 cm ring enhancing lesion with massive surrounding edema was revealed. Despite osmotic diuretics to relieve brain edema, symptoms worsened, so decompressive right temporal craniotomy and total excision of the tumor was performed. This mass lesion was found to be extra axial, with histology revealing on atypical meningioma with massive necrosis. This rare case which is thought to be due to massive peritumoral edema, possibly from an ischemic occluded major feeder, conforms to glioma radiologically; while the clinical picture has a similarity to brain abscess. This case is presented as a reminder to neurosurgery practice that meningioma can also be a possibility when a ring enhancing cerebral mass in encountered and is accompanied by such a bizarre sudden and rapidly progressing neurologic condition.