The Fate of Clinically Unrecognized Intracranial Meningiomas

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Abstract
Meningiomas are known to exist within the cranial cavity over considerable periods of time before making their presence known. Although of slow growth, symptoms may be ushered in quite rapidly which may lead to erroneous conclusions regarding the cell type of lesion, and in many instances obscure the true cause from cerebral vascular icti or altered consciousness secondary to metabolic or cardiorenal disorders. History and clinical course of 10 cases of individuals harboring intracranial meningiomas are given in detail to illustrate those features which influence the failure to recognize the presence of a meningioma. Among the 10 cases only 2 were considered as brain tumor suspects on admission to hospital, whereas the remaining 8 were admitted with a variety of diagnoses, the most common being that of vascular ictus. This diagnosis was influenced by the age range of 51-83 years. None of the 10 patients were considered as brain tumor suspects prior to admission to hospital despite suggestive and overt symptoms and signs of brain tumor. These endured from 1 month to 5 years in 7 patients while in 3 no symptoms referable to brain tumor were present before admission to hospital. Headache and mental symptoms were the most frequent early signs, symptoms which are also characteristic of cerebral vascular disorders. The most common objective findings consisted of motor defects and mental abnormalities, likewise commonly encountered in cerebral vascular disease. Five patients developed sudden apoplectiform onset resulting in the diagnosis of cerebral thrombosis or hemorrhage. This may also occur in hemorrhage within a glioma. Three of the cases studied in hospital were considered to be gliomas. Clinical criteria and ancillary aids are far from infallible in differentiating meningiomas from gliomas, hence exploratory craniotomy with inspection is advised. Five patients were operated after study disclosed brain tumor. Five patients died from within 35 minutes to 38 days after admission to hospital and among these, meningioma was a fortuitous finding at autopsy. Attention is called to the need for "tumor-consciousness" regarding patients past 50 in whom the presenting clinical features resemble the more commonly encountered vascular, metabolic, toxic, psychotic, or inflammatory syndromes.

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