Malignant meningioma--a rare cause of temporal head lump

Abstract

A 78-year-old lady was admitted to the medical assessment unit with a painful right foot, particularly the great toe. Examination revealed synovitis of the first metatarsophalangeal joint on the right foot with surrounding erythema and swelling. Full blood count, renal profile, bone profile, liver profiles were normal. Inflammatory markers (C-reactive protein) were only mildly elevated at 17, along with serum urate at 366 mmol/l. A clinical diagnosis of gout was made and she was treated with non-steroidal anti-inflammatories. During her examination however, it was noticed she had a lump on the right temporal region of the head which she claimed had been there for 12 years. She occasionally experienced pains around the lump, which had previously been put down to neuralgia. The lump was round, 4 × 3 cm, and ∼1.5 cm at its greatest depth. It appeared tethered to the skull (Figure 1). Full neurological examination was unremarkable, with no visual field defects or abnormalities on fundoscopy. Skull X-ray revealed some periosteal elevation associated with the lump and further imaging was advised. Brain magnetic resonance imaging (MRI) showed an avidly contrast enhancing dural-based mass ∼7.5 × 6.8 cm in its largest diameters in the right temporoparietal region causing significant mass effect with subfalcine herniation and significant peritumoural oedema (Figure 2). Computer tomography (CT) of …