Hemorrhagic Atypical Planum Sphenoidale Meningioma with Intermittent Vision Loss—Rare Presentation of Apoplexy

Abstract

Background: Symptoms that mimic pituitary apoplexy may be encountered with other neoplastic or infectious lesions. Case Description: This 38-year-old man presented with severe sudden-onset headache and relapsing and remitting vision loss. Radiographic imaging studies demonstrated radiographic features of a hyperdense, hemorrhagic mass in the sellar region. Magnetic resonance imaging (MRI) revealed a 4-cm mass abutting the optic chiasm and compressing the pituitary. After 4-week follow-up, surveillance MRI demonstrated near-complete resolution of the previously identified planum sphenoidale and suprasellar mass. The patient re-presented 13 months later with recurrent symptoms. MRI demonstrated recurrence of the mass. Given the broad differential diagnosis, an endoscopic endonasal biopsy was obtained; the findings were suggestive of a high-grade meningioma. The patient underwent elective resection of the extraaxial lesion via a frontotemporal approach. The lesion was identified as a hemorrhagic suprasellar atypical planum sphenoidale meningioma. Postoperatively, the patient's headaches improved significantly and his right-sided visual changes resolved. After adjuvant radiotherapy (5400 cGy in 30 fractions) to the surgical cavity 3 months later, at last follow-up 5 months postoperatively, the patient was at his neurologic baseline and denied any headaches or visual sequelae. Conclusions: As the most common benign intracranial tumors, meningiomas should remain in the differential for patients presenting with apoplectiform symptoms.