2345 Meningioma encasement of the internal carotid artery as a rare cause of stroke

A 62 year old woman with a history of hypertension presented to the hospital with sudden onset left sided hemiplegia. She also complained of headaches and visual blurriness days leading up to admission. On examination, she was found to have dense left-sided hemiplegia, hemianopia and neglect with a National Institute of Health Scale Score (NIHSS) of 12. CT of the brain and neck angiography revealed an occlusion of the right internal carotid artery (ICA) and bifrontal oedema. Subsequent MRI (including DWI, SWI, T1 with gadolinium contrast, and T2 FLAIR) showed infarction overlying the right M2 territory with a large frontal meningioma. The meningioma was also found to have encased the right ICA. The patient was commenced on aspirin and dexamethasone. The patient then underwent inpatient rehabilitation was referred to neurosurgery for further observation. The case highlights meningioma encasement of ICA as a rare cause of ICA occlusion, leading to stroke

Meningiomas more commonly cause transient ischaemic attacks (TIAs) due to encasement of carotid arteries, leading to vascular insufficiency. There are few reported cases of meningiomas causing strokes.^{1 2} The internal carotid artery at the base of skull has reduced flexibility as it is near bony structures and is fixed with the dura mater and arachnoid mater.^3–5 Occasionally this allows slow-growing meningiomas to eventually encase and obstruct the ICA.⁶ In most situations, collateral flow from the Circle of Willis compensates for this.⁶

References

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