Brain Pathology Case of the Month - April 2000

Contributed by Judit Miklossy MD1, Zsolt Kopniczky MD2, Antoine Uske MD3
     Françoise Delacrétaz MD1, Pascal Chaubert MD1, François Porchet MD2

     University Hospital and Medical School of Lausanne
     Departments of 1Pathology (Division of Neuropathology) 2Neurosurgery and 3Neuroradiology.
Published on line in April 2000


This 43-year-old man presented with a "seizure" of dizziness, associated with difficulty in walking and performing simple movements. Four months later the same symptoms were accompanied with partial, and six months later with generalized epileptic seizures.Upon admission the patient complained of diffuse headache and some difficulties in finding words. Neurological and neuropsychological examinations did not reveal any motor, sensory, cognitive deficits, nor speech disturbances. Electroencephalography (EEG) showed a dysrythmic region with oppositional-phase waves in the left fronto-parietal region with a normal background activity, without epileptic activity.


Cerebral magnetic resonance imaging (MRI) revealed an extra-axial, parasagittal, tumor of 2.5cm of diameter in the left parietal region (Figure 1). The lesion was iso-intense on T1- and slightly hyper-intense on T2 weighted images, with homogenous contrast enhancement after Gadolinium administration. The tumor was attached to the dura without deforming the sagittal sinus but compressing the underlying brain parenchyma. Four-vessels digitally subtracted angiography showed that tumor to be supplied by a parietal branch of the left middle meningeal artery (Figure 2).


Left sided parietal craniotomy and complete resection of the well delineated extra-axial tumor was performed. The postoperative course was uneventful.



International Society of Neuropathology