Meningioma

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1. Identify hyperdense mass
   Meningioma

2. Where does it arise from
   Arachnoid cap cells

3. What structure might it compress
   Superior sagittal sinus

4. What structures does it lie between
   Falx and cerebral hemisphere

5. What will patient present with
   Monoparesis contralateral LL

6. What area of brain affected
   Motor area 4

7. What area body represented medial side of motor area
   Lower Limb

8. Which layer of meninges is the meningioma attached to
   Primary motor cortex

9. Which layer of meninges is menigionoma attached to

10. What is major vein draining brain parenchyma

11. What drains into dural sinuses

12. Branches of middle cerebral artery

13. Signs of MCA infarction

14. Identify hyperdense mass

Answer: Meningioma ✅

Usually extra-axial, well-circumscribed, often hyperdense on CT.

2. Where does it arise from

Answer: Arachnoid cap cells ✅

Correct. These are in the arachnoid villi of the meninges.

3. What structure might it compress

Answer: Superior sagittal sinus ✅

True for parasagittal meningiomas.

Can also compress adjacent cortex → neurological deficits.

4. What structures does it lie between

Answer: Falx and cerebral hemisphere ✅

Correct. Extra-axial, attached to dura of falx.

5. What will patient present with

Answer: Monoparesis contralateral lower limb ✅

Good. This is classic for parasagittal lesion affecting the leg area of primary motor cortex.

6. What area of brain affected

Answer: Motor area 4 ✅

Yes, Brodmann area 4 = primary motor cortex.

Can also mention paracentral lobule specifically for leg involvement.

7. What area body represented medial side of motor area

Answer: Lower Limb ✅

Correct.

Lateral = face and hand; medial = leg and foot.

8. (Missing) → Likely MRCS-style question

Could be one of these:

Q8: “Which layer of meninges is the meningioma attached to?”

Answer: Dura mater ✅

Meningiomas are dural-based tumours, hence the “dural tail” sign on imaging.

9. Primary motor cortex

Answer: Already mentioned (area 4). ✅

10. Which layer of meninges is meningioma attached to

Answer: Dura mater ✅

Correct.

11. What is major vein draining brain parenchyma

Answer: Internal cerebral veins / deep cerebral veins

Superficial drainage → superficial cortical veins → dural sinuses.

12. What drains into dural sinuses

Answer: Cerebral veins (superficial and deep), diploic veins, emissary veins, CSF via arachnoid granulations ✅

13. Branches of middle cerebral artery

Answer:

Lateral lenticulostriate arteries (deep)

Cortical branches → frontal, parietal, temporal, insular cortices

14. Signs of MCA infarction

Answer:

Contralateral hemiplegia and hemianesthesia (face and upper limb > leg)

Contralateral homonymous hemianopia

Aphasia if left hemisphere dominant

Neglect if right hemisphere

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Typical exam stem:

A 55-year-old woman presents with gradually progressive weakness of one leg. She also reports focal seizures affecting the same limb. Examination shows monoparesis of the contralateral lower limb with increased tone and brisk reflexes.

Most likely diagnosis:
A Parasagittal meningioma

The tumour grows along the Falx cerebri and compresses the medial surface of the brain where the leg motor area lies in the Paracentral lobule of the Primary motor cortex.

Because the Corticospinal tract crosses in the Pyramidal decussation, the weakness appears on the opposite side.

Classic MRCS clinical features
Feature Reason
Contralateral lower limb monoparesis Leg area of motor cortex compressed
Focal motor seizures in the leg Cortical irritation
Slow progression Typical for benign meningioma
Upper motor neuron signs (hyperreflexia, Babinski) Corticospinal tract involvement
Imaging clue

MRI usually shows an extra-axial tumour with a dural attachment (“dural tail”), typical of a Meningioma.

“Falx tumour → opposite leg weak.”
Falx / parasagittal location
Leg motor cortex affected
Weakness contralateral

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1. Parasagittal meningioma

Tumour: Parasagittal meningioma

Typical presentation

Gradually progressive contralateral lower limb weakness

Focal seizures in the leg

UMN signs

Why
Compression of the Paracentral lobule (leg area of the Primary motor cortex).

Exam clue

Progressive leg weakness + seizures → parasagittal meningioma.

2. Acoustic neuroma (vestibular schwannoma)

Tumour: Vestibular schwannoma

Typical presentation

Unilateral hearing loss

Tinnitus

Balance problems

Later:

Facial numbness

Facial weakness

Why
Compression of:

Vestibulocochlear nerve (CN VIII)

Facial nerve (CN VII)

Exam clue

Progressive unilateral deafness.

3. Pituitary adenoma

Tumour: Pituitary adenoma

Typical presentation

Bitemporal hemianopia

Why
Compression of the Optic chiasm.

Other clues:

Hormonal symptoms (galactorrhoea, acromegaly, Cushing's).

Exam clue

Loss of temporal visual fields.

4. Cerebellopontine angle tumour

Often a Vestibular schwannoma.

Symptoms

Hearing loss

Facial numbness

Ataxia

Structures involved:

Trigeminal nerve

Facial nerve

Vestibulocochlear nerve

Exam clue

Multiple cranial nerve deficits in the cerebellopontine angle.

5. Frontal lobe tumour

Commonly a Glioma.

Typical presentation

Personality change

Disinhibition

Poor judgement

Sometimes urinary incontinence

Structure affected:

Frontal lobe

Exam clue

Behavioural change before neurological deficit.

✅ Very high-yield MRCS pattern

Symptom Likely tumour
Leg weakness Parasagittal meningioma
Unilateral deafness Vestibular schwannoma
Bitemporal hemianopia Pituitary adenoma
Behaviour change Frontal lobe tumour
Multiple cranial nerve palsies CPA tumour