Giant Meningioma Diagnosis and Clinical Treatment: A Case Report

TL;DR

A rare case of foot drop caused by a giant meningioma highlights the need for comprehensive neurological evaluation to identify central nervous system tumors.

Contribution

This case report presents a rare instance where foot drop was caused by a giant meningioma, emphasizing the importance of considering central causes in diagnosis.

Findings

Initial imaging ruled out lumbar pathology, but a brain MRI later revealed a giant meningioma.

Surgical resection after embolization led to full recovery of hemiparesis.

Foot drop can be a rare manifestation of intracranial tumors and requires CNS imaging for accurate diagnosis.

Abstract

This case report shows the importance of semiology during a clinical examination not only to diagnose spine clinical symptoms but also to review the central nervous system tumor as a foot drop cause. We report a unique case of a patient who consulted for constant progressive numbness and motor symptoms in the right lower extremity. Lumbar CT and MRI were negative for acute or chronic lumbar pathology. This is a 41-year-old female patient with a history of eight-month progressive right leg weakness. The physical examination did not reveal neurological alterations besides foot drop. MRI and lumbar X-rays showed no significant findings. Electromyography (EMG) indicated right peroneal neuropathy. Based on these findings, surgical treatment was not indicated; therefore, physical therapy and a referral to neurology were indicated. However, symptoms increased, resulting in a right lower extremity hemiparesis. A brain MRI showed a left frontoparietal giant meningioma, which was surgically resected after embolization. The patient evolved with a full recovery of the right-sided hemiparesis after surgery. Our case highlights the foot drop's multiple etiologies. Initially, a lumbar disc hernia was suspected, but it was ruled out by imaging studies. Later, the EMG revealed peroneal neuropathy, leading to a neurology consult. Unexpectedly, a giant intracranial meningioma was found, a rare case of foot drop. A consideration of upper motor neuron (UMN) and lower motor neuron (LMN) syndromes aided diagnosis. Tumoral resection with embolization resulted in significant improvement, showcasing the complexities of such cases. Foot drop is a peculiar clinical manifestation that must have an integral assessment to rule out peripheral and central causes. Even rare, giant meningiomas can cause focalized symptoms such as foot drop. Therefore, the assessment of foot drop should include the CT and MRI of the central nervous system.

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