An unusual presentation of subfrontal meningioma: a case report and literature review for Foster Kennedy syndrome

Abstract

Intern Emerg Med (2011) 6:267–269 DOI 10.1007/s11739-010-0437-y CE - MEDICAL ILLUSTRATION An unusual presentation of subfrontal meningioma: a case report and literature review for Foster Kennedy syndrome Shahram Lotfipour • Kris Chiles • J. Akiva Kahn Tareg Bey • Scott Rudkin Received: 17 December 2009 / Accepted: 13 July 2010 / Published online: 26 August 2010 O SIMI 2010 Introduction Foster Kennedy syndrome, named after neurologist Robert Foster Kennedy (1884–1952), describes unilateral ipsilat- eral optic atrophy and contralateral papilledema from an intracranial mass. This syndrome is unreliably associated with anosmia and ipsilateral proptosis [1]. It originates from variety of intracranial pathologies, but most often a subfrontal mass. We present a case of Foster Kennedy syndrome and review its etiology, pathology and incidence in intracranial tumors. Case report A 47-year-old woman was brought in by her family to the Emergency Department (ED) for psychiatric care. The patient had been homeless for 17 years prior to the visit, but had recently been taken in by her family, and brought in for evaluation of her personality changes. She denied any recent S. Lotfipour T. Bey S. Rudkin Irvine School of Medicine, University of California, Orange, USA K. Chiles Highland General Hospital, Oakland, USA J. A. Kahn Thomas Jefferson University, Philadelphia, USA S. Lotfipour (&) Department of Emergency Medicine and Public Health, Clinical Science Education, University of California, Irvine School of Medicine, 200 S. Manchester Avenue, Suite 710, Orange, CA 92868, USA e-mail: SHL@uci.edu head trauma. She admitted to abusing crack cocaine for 13 years with her last use 4 months ago. She denied any trouble with ambulation, dizziness, and changes in hearing or other alterations in sensation. She denied any suicidal or homicidal ideation. The patient denied any auditory halluci- nations, but did report that she had been experiencing visual hallucinations and visual disturbances for at least 6–8 months. She reported complete blindness in the left eye, and shadow perception in her right for an unknown length of time. Her past medical history was notable for major depression. The patient did not have a previous history of hallucinations or psychosis, and had never been hospitalized for psychiatric reasons. The patient was not on any medica- tions, and was allergic to penicillin and codeine. The gyne- cologic, surgical and family histories were noncontributory. Initial vital signs were: temperature 36.9°C, pulse 86 beats/min, blood pressure 95/63 mm/Hg, respiratory rate 16 breaths/min, and oxygen saturation 100% on room air. On physical examination, the patient was alert and oriented to person, place and time. Her left pupil was nonreactive to direct light with a normal consensual light response and inability to count fingers with either eye. Extraocular movements were intact and cranial nerves IV through XII were normal. Further evaluation revealed she had anosmia, left optic nerve atrophy and right papilledema. Laboratory studies were normal and urine toxicology was negative. Per hospital protocol initially a non-contrast computed tomography (CT) of the head revealed a large homogenous mass in the anterior cranial fossa (Fig. 1) measuring 8.0 9 6.1 cm. The mass had a calcified rim, and had eroded into the ethmoid sinus and bilateral orbits. A magnetic resonance imaging (MRI) confirmed the diagnosis of a subfrontal meningioma (Fig. 2). The patient was started on phenytoin for seizure pro- phylaxis and dexamethasone to reduce cerebral edema. She