Anterior Cerebral Infarction by Fronto-Basal Meningioma
278
A B
C D
Figure 1. CT scan without injection (A), (B) and injection
(C), (D) showing a frontal meningioma infiltrating anterior
cerebral artery with infarction in the left calloso marginal
artery territory.
3. Discussion
We present the case of meningioma associated to ische-
mic stroke. The occurrence of stroke in patients with a
brain tumor has been described, vascular occlusion is
related to either direct compression or vascular infiltra-
tion by the tumor, or indirectly by coagulation disorders
[4,5]. Meningiomas are the most common benign tumors
in adults, and the para sagittal, fronto-basal or skull base
localizationare usual as our patient [6,7]. By their loca-
tion few cases of transient ischemic injury have been
reported, Komotar et al. [8] estimated to 0.19% the inci-
dence of meningioma related cerebral ischemia by ca-
rotid artery compression. The possible pathophysiologi-
cal mechanism in our case is vascular compression by
tumor infiltration, or vascular insufficiency as related in
literature [9,10]. Two cases of cerebral infarction by tu-
mor invasion of the internal carotid were reported by
Komotar et al. [8]. The offending mechanism is was
probably a combination of hypoperfusion and throm-
boembolism. Although common, the fronto-basal loca-
tion of meningioma is rarely reported as a cause of in-
farction in the anterior cerebral artery territory. However
Lévêque et al. [6], in their series of meningiomas of the
midline were found 32.7% of the infiltration of the ante-
rior cerebral artery. The anterior cerebral artery occlusion
directly due to meningioma was recently documented by
Masuoka et al., [9]. The management of our patient was
not optimal, due to the limitations of radiological explo-
rations and neurosurgery conditions in Congo. Without
others contraindications thrombolysis with rt-PA can be
used in acute stroke associated to meningioma [11,12]
and, in some cases endovascular treatment was used be-
fore tumor surgery [10]. In our case, partial recovery of
neurological impairment is due to steroid treatment and
early rehabilitation, because outcome depend on treat-
ment and early rehabilitation [13].
4. Conclusion
The fronto-basal meningioma is a rare cause of the ante-
rior cerebral infarction, although the compression me-
chanism is poorly reported due to the very slow evo-
lution and non-inv asive nature of th e tumor. The vascu lar
insufficiency and hemodynamic change are the most of-
fending mechanisms.
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