Dorsal Psammomatous Meningioma Revealed by Sciatica Case Report

Abstract

Introduction: Meningiomas are benign tumors most localized in brain. Intraspinal meningiomas are rare and may have an intra or extradural topography. We report the case of a dorsal psammomatous meningioma revealed by sciatica. Case description: We present a 58-year-old female hospitalized for bilateral painful and disabling L5 sciatica rebellious to medical treatment and physiotherapy. At physical examination, she presented a lumbar spinal syndrome without root deficit. MRI (Magnetic Resonance Imaging) showed a borderline lumbar canal with a paramedian L4-L5 herniated disc. She undergone a first surgery a L4 decompressive laminectomy and there was no postoperative complications. The follow-up was marked by partial pain regression. Three months later, after a fall she presented low back pain and progressive worsening gait troubles. A MRI was realized and shown L3-L4, L4-L5 duct narrowing. A second surgery a L3 and L5 decompressive laminectomy was performed. The postoperative follow up was characterized by the worsening of the motor deficit to 2/5 associated with brisk osteotendinous reflexes. A medullary MRI was realized, showing an intradural but extra-medullary compressive lesion facing D1-D2. The indication of tumor removal was made and complete resection was performed. She totally recovered from the deficit and the pain. The pathology report showed a psammomatous meningioma. Conclusion: This case report emphasizes the atypical clinical presentation of spinal meningiomas and the importance of a meticulous neurological examination to avoid misdiagnosis.