A 43-year-old, right-handed woman is evaluated in the clinic for progressively worsening neurologic symptoms. The patient has a history of diabetes mellitus and hyperlipidemia for which she takes metformin and a statin. She has no history of head trauma or seizures. The patient occasionally drinks wine but does not use tobacco or illicit drugs. Her mother has a history of migraine headaches. A brain MRI is obtained and is shown in the image below: This patient is most likely to have which of the following additional findings?

Question

A 43-year-old, right-handed woman is evaluated in the clinic for progressively worsening neurologic symptoms.  The patient has a history of diabetes mellitus and hyperlipidemia for which she takes metformin and a statin.  She has no history of head trauma or seizures.  The patient occasionally drinks wine but does not use tobacco or illicit drugs.  Her mother has a history of migraine headaches.  A brain MRI is obtained and is shown in the image below:  This patient is most likely to have which of the following additional findings?

Quizplus · Accepted Answer

11ec160b_359c_9be1_9249_213a83f52e69_MD0001_00 This patient with progressive neurologic symptoms and a well-circumscribed parasagittal tumor most likely has a meningioma. Meningiomas are benign, slow-growing intracranial tumors that typically affect adults and tend to arise near dural reflections (eg, falx cerebri, tentorium cerebelli). Patients are often asymptomatic but may have headache, seizure, or focal neurologic deficits depending on tumor size and location. The tumor's parasagittal location compresses the medial portion of the cerebral cortex, which has a somatotopic organization. The medial portion corresponds with the lower extremities, while the lateral portion corresponds with the trunk and upper extremities. This patient's tumor is affecting the medial portion of the postcentral gyrus (primary somatosensory cortex), most likely resulting in sensory loss in the contralateral lower limb. Involvement of the adjacent parietal association cortex (particularly in the nondominant hemisphere as in this patient) can result in contralateral hemineglect due to this region's role in visuospatial processing. (Choice A) Bitemporal hemianopia can occur due to compression of the central portion of the optic chiasm and is commonly caused by pituitary masses or craniopharyngiomas. (Choice B) Hand weakness and spasticity can occur with meningiomas over the lateral convexity compressing the lateral portion of the primary motor cortex in the frontal lobe. (Choice D) Tinnitus and unilateral hearing loss are common presenting features of vestibular schwannoma, a peripheral nerve tumor characteristically located at the cerebellopontine angle. (Choice E) Unilateral ptosis and gaze palsy ("down and out" gaze) are characteristic of oculomotor nerve palsy, which may occur with nerve damage due to compression (eg, berry aneurysm, uncal herniation) or microvascular ischemia (eg, diabetes mellitus). Educational objective: Meningiomas are common adult intracranial tumors that typically arise in regions of dural reflection (eg, falx cerebri, tentorium cerebelli). Parasagittal lesions compressing the medial portion of the primary somatosensory cortex in the parietal lobe can result in contralateral lower limb sensory loss along with contralateral hemineglect if there is also damage to the parietal association cortex (nondominant hemisphere). __________ References: Meningioma. (http://www.ncbi.nlm.nih.gov/pubmed/18342535) Intracranial meningiomas: an overview of diagnosis and treatment. (http://www.ncbi.nlm.nih.gov/pubmed/17961033)

A 43-Year-Old, Right-Handed Woman Is Evaluated in the Clinic for Progressively