Hemichorea and dystonia due to frontal lobe meningioma

Abstract

Tumors originating from the meninges, also known as meningiomas, have rarely been known to cause parkinsonian symptoms and other movement disorders. Although some cases of AV malformations causing movement disorders have been described in the literature, not much has been reported about meningiomas in this regard. The aim of this case report is to further highlight the importance of brain imaging in patients with movement disorders for even a benign tumor; and also emphasize the need for a careful movement disorder examination because more than one phenomenology of movement disorders may result from the mechanical pressure caused by a tumor. We present a case report of a patient with a heavily calcified right frontal lobe meningioma. Our patient had irregular, involuntary, brief, fleeting and unpredictable movements of her left upper and lower extremities, consistent with chorea. The patient also had abnormal dystonic posturing of her left arm while walking. This case report highlights the importance of brain imaging as well as careful neurological examinations of patients with benign meningiomas. Moreover, it illustrates the remarkable specificity yet clinical diversity of meningiomas in presentation through movement disorders.

Keywords: Dystonia; frontal lobe; hemichorea; meningioma.

Figure 1

T1-weighted MRI with contrast, axial view demonstrating right frontal lobe lesion with inhomogeneous enhancement

Figure 2

Axial view of FLAIR MRI demonstrating hyperintense right frontal lobe lesion measuring 3.7 × 3.5 × 3.2 cm with minimal mass effect and no edema