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VII./4.2.: Symptoms
Symptoms of meningiomas could be divided to three groups, just as well as the signs of other intracranial tumors. Deficit symptoms (focal signs) due to localisation because of the lesion of the adjacent brain tissue, epileptic seizures because of cortical damage as a positive sign and herniations because of space occupying lesion and increased intracranial pressure are possible.
Diverse symptomatology because of diverse localisation is observed. Nowadays, advanced neuroimaging made classical, fully developed clinical syndromes rare; patients frequently diagnosed complaint and symptom free, or only by complaint.
Symptoms determined by localisation, which usually follows the distribution of arachnoideal villi, but meningiomas could arise anywhere in the intracranial space, even rare extracranial forms are known. The most frequent locations of the meningiomas in decreasing order are parasaggital, parafalcial, near the cavernous sinus, lamina cribrosa (olfactory meningiomas), around the foramen magnum and around the exit sites of the nerves. Spinal meningiomas occur most frequently in the thoracic part.
Parasagittal meningiomas are the most frequent (17-20%), and most likely in frontal location. Even a huge tumor could cause symptoms quite late (usually lower limb focal seizure or frequently Jackson seizure). Meningiomas arise from the frontal part of the falx behave similar as the parasagittal frontal tumors: paraparesis, urinary incontinence, prefrontal signs and dementia are characteristic. In patients with frontobasal meningioma, half have visual- and olfactory disturbance, headache, third have cognitive complaints and 20% suffer epileptic seizure.
Meningiomas near the cavernous sinus, tuberculum sellae frequently cause painless exophtalmus, chemosis, ophtalmoparesis or total ophtalmoplegia could happen as well. Compression of the optic nerve result in monocular blindness with atrophy of the papilla, oedema of the contralateral papilla develops later because of the mass lesion of the slowly growing tumor. It is called Foster-Kennedy syndrome, characteristic to the meningiomas of sphenoid wing. Posterior fossa meningiomas rarely evoke epilepsy, but frequently cerebellar and cranial nerve signs.
Typical symptomatology of the pontocerebellar meningiomas are the hypacusis, peripherial facial nerve palsy and trigeminal nerve lesion, similar to the accustic schwannomas. Compression of the facial nerve could cause hemifacial spasm or facial myokimia as well. Rare intraventricular meningiomas cause hydrocephalus, while the en-plaque meningiomas spread flat on the surface of the skull base could cause multiple cranial nerve damage. Multiple meningiomas found in 1-16% of cases.
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Meningiomas of the skull base accompanied with wide variety of symptoms and syndromes just as other tumors in a similar location:
1. Location of the menigioma: anterior fossa/lamina cribrosa
Characteristic symptoms: unilateral or bilateral anosmia, behavioural changes, epilepsy
Differential: olfactory neuroblastoma; spreading disorders of the paranasal sinuses.
2. Location of the menigioma: superior orbital fissure
Syndrome: Rochon-Dovigneau
Characteristic symptoms: lesion of the III, IV, VI and V/1 cranial nerve, exophtalmus
Differential: thrombosis of the cavernous sinus, giant aneurysm of the internal carotid artery
3.: Location of the menigioma: sphenoid wing
Syndrome: Gowers-Foster Kennedy
Characteristic symptoms: ipsilateral atrophy of the papilla, contralateral oedema of the papilla
4. Location of the menigioma: orbit
Syndrome: Jacod-Rollet
Characteristic symptoms: visual disturbance, central blindness (scotoma), papilla oedema, rarely: exophtalmus
Differential: optic glioma, Paget disease, infraclinoidal aneurysm of the internal carotid artery
5. Location of the menigioma: sinus cavernous
Syndrome: Foix-Jefferson
Characteristic symptoms: anterior-superior syndrome: same as superior orbital fissure;
Middle syndrome: previous+ lesion of the V/2;
Caudal syndrome: previous+ lesion of the V/3
Differential: tumors of the hypophysis, nasopharyngeal tumors, aneurysm of the internal carotid artery, carotido-cavernous fistula, thrombosis
6. Location of the menigioma: pyramid of the temporal bone
Syndrome: Gradenigo-Lannois
Characteristic symptoms: lesion of the V and VI. cranial nerve and neuralgia
Differential: otitis, cholesteatoma,
7. Location of the menigioma: sphenoid bone, temporal bone, pars petrosa
Syndrome: Jacod; Petrosphenoidal syndrome
Characteristic symptoms: damage of the III, IV, VI nerves (ophtalmoplegia), amaurosis, trigeminal neuralgia
8. Location of the menigioma: foramen jugulare
Syndrome: Vernet
Characteristic symptoms: paresis of the IX, X, XI nerves
Differential: tumor of the glomus jugulare, neurinoma, tumors of the clivus,
9. Location of the menigioma: anterior occipital condylus
Syndrome: Collet-Sicard (Vernet-Sargnon)
Characteristic symptoms: paresis of the IX, X, XI and XII nerves
10. Location of the menigioma: unilateral half of the skull base
Syndrome: Garcin (Guillain-Alajouanine-Garcin)
Characteristic symptoms: unilateral diverse cranial nerve damage
Differential: basilar meningitis, meningitis carcinomatosa
11. Location of the menigioma: pontocerebellar angle
Characteristic symptoms: cranial nerve VIII (hypacusis, vertigo, nystagmus), cerebellar symptoms, lesion of the V and VII nerve, or in rare cases damage of the IX-X nerves; late phase: increased intracranial pressure, brainstem symptoms
Differential: accustic neurinoma, metastasis, cholesteatoma, basilar aneurysm
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