Neurology: Case of the Month

Test Yourself — Patient 62

Meningioma of the skull base, presenting with multiple cranial nerve palsies

1. Which of the following statements about tumors located at the skull base is FALSE?
   • [ A ] A "salt-and-pepper" appearance on MRI is suggestive of paraganglioma.
   • [ B ] Tumor involvement of the internal auditory canal is diagnostic of vestibular schwannoma.
   • [ C ] Substantial enhancement with gadolinium may occur in schwannomas.
   • [ D ] Tumor metastasis can involve the meninges, mimicking benign extra-axial tumors.
2. All of the following statements about meningiomas are true EXCEPT:
   • [ A ] Meningiomas often arise from the arachnoid granulations.
   • [ B ] Meningiomas do not occur outside the CNS dural linings.
   • [ C ] Meningiomas are typically vascular tumors.
   • [ D ] Progesterone and estrogen receptors have been found on meningiomas.
3. Which of the following statements regarding imaging of meningiomas is NOT true?
   • [ A ] Meningiomas strongly enhance on MRI with gadolinium contrast.
   • [ B ] Meningiomas appear as hyperdense on CT without contrast.
   • [ C ] Enlarged dural feeders may be visualized on angiography as a "sunburst" pattern.
   • [ D ] The appearance of a "dural tail" is specific for meningiomas.
   • [ E ] Meningiomas appear as isointense to gray matter on T1-weighted MR sequences without contrast infusion.
4. Which of the following statements is TRUE?
   • [ A ] Histologically typical meningiomas have recurrence rates of 15-20%.
   • [ B ] Location and histology are the most important contributing factors to a favorable outcome.
   • [ C ] CT scans with contrast detect only 50% of meningiomas.
   • [ D ] The rate of complete resection of meningiomas along the skull base is substantially lower than that for meningiomas located along the cerebral convexity.
5. Which of the following presentations is MOST likely to result from meningioma?
   • [ A ] Multiple extra-axial parasagittal masses with substantial meningeal enhancement, in a patient with headache.
   • [ B ] A single intra-axial mass encroaching on the cerebello-pontine angle, with indistinct borders, substantial surrounding edema and intense enhancement after gadolinium administration, in a patient with vomiting.
   • [ C ] A single extra-axial mass with petrous bone destruction and a "salt-and-pepper" appearance on MRI, in a patient with pulsatile tinnitus.
   • [ D ] A semilunar-shaped, enhancing extra-axial mass extending along the surface of the lower brainstem, with broad-based dural attachment, in a patient with hoarseness and unilateral tongue atrophy.

 

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