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

Abstract

Symptoms that mimic pituitary apoplexy may be encountered with other neoplastic or infectious lesions. 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. As the most common benign intracranial tumors, meningiomas should remain in the differential for patients presenting with apoplectiform symptoms.