Anterior Cerebral Infarction by Fronto-Basal Meningioma

doi:10.4236/nm.2013.44040

Paper Menu >>

Journal Menu >>

Neuroscience & Medicine, 2013, 4, 277-279

Published Online December 2013 (http://www.scirp.org/journal/nm)

http://dx.doi.org/10.4236/nm.2013.44040

Open Access NM

277

Anterior Cerebral Infarction by Fronto-Basal Meningioma

Paul Macaire Ossou-Nguiet1*, Dieu Donné Gnonlonfoun2, Karen Obondzo-Aloba1,

Hugues Brieux Ekouélé-Mbaki1, Gilbert Fabrice Otiobanda3

1Department of Neurology, University Hospital of Brazzaville, Brazzaville, Congo; 2Department of Neurology, University Hospital

of Cotonou, Cotonou, Benin; 3Department of Intensive Care, University Hospital of Brazzaville, Brazzaville, Congo

Email: *[email protected]

Received August 31st, 2013; revised September 25th, 2013; accepted October 23rd, 2013

License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

The association between stroke and meningioma is rarely reported in the data. In most etiology classification, there is

no compressive cause. The association between meningioma and stroke is increasingly reported. We report a case of 52-

year-old woman, previously healthy, presented with sudden right hemiplegia with some transient mood disorders. The

CT-scan revealed acute left anterior cerebral artery infarction associated with fronto-basale meningioma infiltrating

both anterior cerebral arteries. She was treated by corticosteroid and rehabilitation, with partial recovery. No stroke pre-

vention was used before surgical treatment.

Keywords: Infarction; Anterior Cerebral Artery; Meningioma

1. Introduction

Mechanisms and causes of cerebral infarction are well

studied and documented in the literature, and usually two

mechanisms are identified: hemodynamics and throm-

botic or thromboembolic causes [1]. Compressive causes

by tumor are not reported in the main etiological classi-

fications as Trial of Org1017 2 in Acute Stroke Treatment

(TOAST) classification and ASCO (atherosclerosis, small

vessel disease, cardiac source, other causes) [2]. Men-

ingioma is the second most common primary brain tumor

with incidence rates of 3 to 13 cases per 100,000. That

incidence increases with female gender and age [3 ], an d i t

is the most common benign tumor in adult, which is usu-

ally manifested by slow progressive signs. The occur-

rence of stroke associated with meningioma is increas-

ingly reported, but there is no cohort study. We report a

case of sudden neurological deficit due to calloso-mar-

ginal branch of the anterior cerebral artery infarction as-

sociated with infiltrating fronto-basal meningioma.

2. Case

It was a patient of 52 years, with no particular history,

admitted to the neurology department for motor deficit of

the right side of the body. The examination revealed

some transient episodes of mood disorders without

headache or vomiting. Physical examination on admis-

sion noted a right hemiplegia predominantly on lower

limb and the presence of grasping reflexe, without other

elements of the frontal lobe involvement. The blood

pressure was 135/80 mmHg, regular heart without added

noise. The CT scan without injection showed a tumor

lesion isodensefrontobasale parenchyma associated with

infarction in calloso-marginal territory of the anterior

cerebral artery (Figures 1(A) and (B)). A secondary in-

jection revealed homogeneous contrast enhancement of

the lesion characteristic of meningioma. That tumor le-

sion infiltrates both anterior cerebral arteries (Figures

1(C) and (D)). Lipid and inflammatory balance, echocar-

diography, the 24 hours ECG-recording, and echo-Dop-

pler of the supra-aortic trunks founded no abnormalities.

It was not possible to make vascular exploration with

MRI or angiography. The possible tumor origin of the

infarct was selected. The treatment consisted to corticos-

teroid based on prednisolone 1 mg/kg associated with

and motor rehabilitation for 1 month, with partial recov-

ery, then the patient was transferred to neurosurgery de-

partment for surgical management, no stroke prevention

was conducted before surgery.

*Corresponding a uthor.

Anterior Cerebral Infarction by Fronto-Basal Meningioma

278

A B

C D

Figure 1. CT scan without injection (A), (B) and injection

(C), (D) showing a frontal meningioma infiltrating anterior

cerebral artery with infarction in the left calloso marginal

artery territory.

3. Discussion

We present the case of meningioma associated to ische-

mic stroke. The occurrence of stroke in patients with a

brain tumor has been described, vascular occlusion is

related to either direct compression or vascular infiltra-

tion by the tumor, or indirectly by coagulation disorders

[4,5]. Meningiomas are the most common benign tumors

in adults, and the para sagittal, fronto-basal or skull base

localizationare usual as our patient [6,7]. By their loca-

tion few cases of transient ischemic injury have been

reported, Komotar et al. [8] estimated to 0.19% the inci-

dence of meningioma related cerebral ischemia by ca-

rotid artery compression. The possible pathophysiologi-

cal mechanism in our case is vascular compression by

tumor infiltration, or vascular insufficiency as related in

literature [9,10]. Two cases of cerebral infarction by tu-

mor invasion of the internal carotid were reported by

Komotar et al. [8]. The offending mechanism is was

probably a combination of hypoperfusion and throm-

boembolism. Although common, the fronto-basal loca-

tion of meningioma is rarely reported as a cause of in-

farction in the anterior cerebral artery territory. However

Lévêque et al. [6], in their series of meningiomas of the

midline were found 32.7% of the infiltration of the ante-

rior cerebral artery. The anterior cerebral artery occlusion

directly due to meningioma was recently documented by

Masuoka et al., [9]. The management of our patient was

not optimal, due to the limitations of radiological explo-

rations and neurosurgery conditions in Congo. Without

others contraindications thrombolysis with rt-PA can be

used in acute stroke associated to meningioma [11,12]

and, in some cases endovascular treatment was used be-

fore tumor surgery [10]. In our case, partial recovery of

neurological impairment is due to steroid treatment and

early rehabilitation, because outcome depend on treat-

ment and early rehabilitation [13].

4. Conclusion

The fronto-basal meningioma is a rare cause of the ante-

rior cerebral infarction, although the compression me-

chanism is poorly reported due to the very slow evo-

lution and non-inv asive nature of th e tumor. The vascu lar

insufficiency and hemodynamic change are the most of-

fending mechanisms.

REFERENCES

[1] T. Moulin, “Epidémiologie, Physiopathologie des Acci-

dents Vasculaires Cérébraux Ischémiques,” Journal des

Maladies Vasculaires, Vol. 30, No. Suppl 1, 2005, pp. 5-

6. http://dx.doi.org/10.1016/S0398-0499(05)74793-4

[2] W. Y. Shang and J. Y. Liu, “Stroke Subtype Classification:

A Comparative Study of ASCO and Modified TOAST,”

The Journal of Neuroscience, Vol. 314, No. 1-2, 2012, pp.

66-70. http://dx.doi.org/10.1016/j.jns.2011.10.029

[3] H. Van Alkemade, M. De Leau, E. M. Dieleman, J. W.

Kardaun, R. Van Os, W. P. Vandertop, W. R. Van Furth

and L. J. Stalpers, “Impaired Survival and Long-Term

Neurological Problems in Benign Meningioma,” Neuro-

Oncology, Vol. 14, No. 5, 2012, pp. 658-666.

http://dx.doi.org/10.1093/neuonc/nos013

[4] M. Launay, D. Fredy, J. J. Merland and J. Bories, “Nar-

rowing and Occlusion of Arteries by Intracranial Tumors.

Review of the Literature and Report of 25 Cases,” Neuro-

radiology, Vol. 14, No. 3, 1977, pp. 117-126.

http://dx.doi.org/10.1007/BF00333054

[5] T. N. Kreisl, T. Toothaker, S. Karimi and L. M. DeAn-

gelis, “Ischemic Stroke in Patients with Primary Brain

Tumors,” Neurology, Vol. 70, No. 24, 2008, pp. 2314-

2320.

http://dx.doi.org/10.1212/01.wnl.0000314648.82924.6f

[6] S. Lévêque, S. Derrey , O. Mart inaud, E. Gérardin, O. Lang-

lois, P. Fréger, et al., “Superior Interhemispheric Ap-

proach for Midline Meningioma from the Anterior Cra-

nial Base,” Neurochirurgie, Vol. 57, No. 3, 2011, pp.

105-113. http://dx.doi.org/10.1016/j.neuchi.2011.08.001

[7] M. Ishikawa, S. Nishi, T. Aoki, et al., “Predictability of

Internal Carotid Artery (ICA) Dissectability in Cases

Showing ICA Involvement in Parasellar Meningioma,”

Journal of Clinical Neuroscience, Vol. 8, No. Suppl 1,

2001, pp. 22-25.

http://dx.doi.org/10.1054/jocn.2001.0872

[8] R. J. Komotar, S. C. Keswni and R. J. Wityk, “Menin-

gioma Presenting as Stroke: Report of Two Cases and Es-

Open Access NM

Anterior Cerebral Infarction by Fronto-Basal Meningioma

Open Access NM

279

timation of Incidence,” Journal of Neurology, Neurosur-

gery & Psychiatry, Vol. 74, No. 1, 2003, p. 136.

http://dx.doi.org/10.1136/jnnp.74.1.136

[9] J Masuoka, F Yoshioka, H Ohgushi, M Kawashima, T.

Matsushima, “Meningioma Manifesting as Ce rebral Infarc-

tion. Case Report,” Neurologia Medico-Chirurgica (To-

kyo), Vol. 50, No. 7, 2010, pp. 585-587.

http://dx.doi.org/10.2176/nmc.50.585

[10] F. Fernandez-Valverde, E. Jimenez-Gomez, E. Roldan-

Romero and F. Bravo-Rodriguez, “Presurgical Endovas-

cular Treatment of Symptomatic Carotid Stenosis Caused

by a Meningioma of the Planumsphenoidale,” Revue Neu-

rologique, Vol. 56, No. 3, 2013, pp. 157-160.

[11] R. F. Baiense, A. Abrahão, I. F. Ricarte, T. G. Fukuda, R.

A. Oliveira, G. S. Silva, M. Costa and M. J. Teixeira,

“Successful Intra-Arterial Thrombolysis in a Patient with

an Intracranial Meningioma,” Journal of Stroke and Cere-

brovascular Diseases, 2013, in press.

[12] T. Etgen, I. Steinich and L. Gsottschneider, “Thromboly-

sis for Ischemic Stroke in Patients with Brain Tumors,”

ournal of Stroke and Cerebrovascular Diseases, 2013, in

press.

[13] M. Bartolo, C. Zucchella, A. Pace, G. Lanzetta, C. Vec-

chione, M. Bartolo, G. Grillea, M. Serrao, C. Tassorelli,

G. Sandrini and F. Pierelli, “Early Rehabilitation after

Surgery Improves Functional Outcome in Inpatients with

Brain Tumours,” Journal of Neuro-Oncology, Vol. 107,

No. 3, 2012, pp. 537-544.

http://dx.doi.org/10.1007/s11060-011-0772-5