A meningioma is a tumor of the membranes that cover the brain and spinal cord, and most are benign and grow slowly. Many are found by chance on a scan, while larger ones cause symptoms by pressing on nearby brain or nerves.
Key symptoms
- Headache that slowly worsens
- Seizures
- Vision changes or loss of smell
- Gradual weakness, personality change or memory problems
What you find on exam
- Full neurological exam for focal deficits
- Visual fields and cranial nerves
- Fundoscopy for papilledema
- Mental status and behavior
Tests
- MRI brain with contrast: well-defined mass attached to the dura
- CT head to look for calcification or bone changes
- Follow-up MRI to measure growth in small tumors
- Tissue diagnosis after surgery to grade the tumor
Treatment basics
- Observation with serial MRI for small tumors without symptoms
- Surgical removal for symptomatic or growing tumors
- Radiation or radiosurgery when surgery is not possible or removal is incomplete
- Dexamethasone for swelling and antiseizure medicine if seizures
Red flags
- Signs of raised pressure: worsening headache, vomiting, drowsiness
- New seizure
- Sudden vision loss or new focal weakness
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.