A Rare Cause of Stroke in Young Adults: Occlusion of the Middle Cerebral Artery by a Meningioma Postpartum

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. 1. Introduction Meningioma is the most common nonglial intracranial primary tumor, accounting for 13 to 26% of all primary intracranial tumors [1]. This slowly growing tumor arises from the arachnoid cells of the leptomeninges and presents clinically by causing seizures along with neurological or neuropsychological deficit [2]. Meningiomas variably express hormone receptors for progesterone, androgen, estrogen, placenta growth factor, and exogenous hormones [3, 4] and are also 2-3 times more common in women than in men [5]. 2. Case Report We report on a 30-year-old right-handed woman with a personal history of migraine admitted to the Department of Neurology, 1 month after childbirth, for acute onset of headache and complete paresis of her left hemibody, without sensory loss; National Institutes of Health Stroke Scale (NIHSS) was 10. Laboratory examination found no abnormality. T1-weighted magnetic resonance (MR) imaging with gadolinium disclosed a right sphenoid wing meningioma measuring 35？mm in diameter (Figure 1(a)). Diffusion-weighted MR imaging showed a hyperintense area in the right deep middle cerebral artery (MCA) territory (Figure 1(b)), indicating acute cerebral infarction; MR angiography sequences revealed interrupted arterial flow in the right MCA (Figure 1(c)). Selective angiography of the right carotid artery demonstrated an occlusion of the M1 portion of the right MCA and a rich vascular stain of the tumor, fed primarily by intracavernous branches of the right carotid siphon (Figure 1(d)). No cause for MCA infarct other than the meningioma was found. The tumor was totally removed. The MCA trunk was set in the meningioma, and a thrombus of the right MCA was observed during the surgery. The final pathological diagnosis confirmed a meningothelial meningioma with progesterone receptor positivity