A rare cause of stroke in young adults: occlusion of the middle cerebral artery by a meningioma postpartum

Abstract

Meningioma is the most common nonglial intracranial primary tumor. It is a slowly growing tumor and presents clinically by causing seizures along with neurological or neuropsychological deficit. However, acute presentation of meningioma is possible. We are reporting a case of cerebral infarction due to a sphenoid wing meningothelial meningioma (with progesterone receptor positivity) leading to an occlusion of the middle cerebral artery (MCA) in a 30-year-old right-handed woman (1 month after childbirth). After surgery, no new neurological event occurred, and she recovered most of her neurological functions. Strokes due to meningioma are a highly rare clinical occurrence but should be given serious consideration, particularly in young patients.

Figure 1

Brain MRI T1-weighted postgadolinium sequence showing homogenous enhancement of the meningioma (a). Brain MRI diffusion-weighted sequence showing acute deep MCA stroke (b). Brain MR angiography (axial sequence) showing occlusion of the right MCA (arrow) (c). Angiogram of the right internal carotid artery showing complete occlusion of the right MCA (arrow) and vascular blush of the meningioma (∗) (d).

Figure 2

Meningothelial meningioma. Hematoxylin eosin staining section (original magnification ×100) showing characteristic cellular whorls (a). Immunohistochemistry (IHC) sections (original magnification ×100): the Ki 67 labelling index (1/100 Dako) indicates a low grade (1-2%) of the meningioma (b); IHC for estrogen receptors (Ventana) showing no positive nuclei (c), whereas IHC for progesterone receptors (Ventana) showing positive nuclei (d).