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      Hemichorea and dystonia due to frontal lobe meningioma

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          Abstract

          Tumors originating from the meninges, also known as meningiomas, have rarely been known to cause parkinsonian symptoms and other movement disorders. Although some cases of AV malformations causing movement disorders have been described in the literature, not much has been reported about meningiomas in this regard. The aim of this case report is to further highlight the importance of brain imaging in patients with movement disorders for even a benign tumor; and also emphasize the need for a careful movement disorder examination because more than one phenomenology of movement disorders may result from the mechanical pressure caused by a tumor. We present a case report of a patient with a heavily calcified right frontal lobe meningioma. Our patient had irregular, involuntary, brief, fleeting and unpredictable movements of her left upper and lower extremities, consistent with chorea. The patient also had abnormal dystonic posturing of her left arm while walking. This case report highlights the importance of brain imaging as well as careful neurological examinations of patients with benign meningiomas. Moreover, it illustrates the remarkable specificity yet clinical diversity of meningiomas in presentation through movement disorders.

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          Typical, atypical, and misleading features in meningioma.

          Meningiomas are the most common nonglial primary tumors of the central nervous system and the most common extraaxial neoplasms, accounting for approximately 15% of all intracranial tumors. They are usually benign neoplasms, with characteristic pathologic and imaging features. However, there are several important histologic variants of meningioma, and even a histologically typical meningioma can have unusual or misleading radiologic features that may not be suggestive of meningioma. The typical meningioma is a homogeneous, hemispheric, markedly enhancing extraaxial mass located over the cerebral convexity, in the parasagittal region, or arising from the sphenoid wing. Meningiomas may originate in unexpected locations such as the orbit, paranasal sinus, or ventricles or be entirely intraosseous (within the calvaria). Unusual imaging features such as large meningeal cysts, ring enhancement, and various metaplastic changes (including fatty transformation) can be particularly misleading. Because meningiomas are so common, the radiologist must be aware of their less frequent and uncharacteristic imaging features in order to suggest the correct diagnosis in cases that are atypical.
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            THE MENINGIOMAS (DURAL ENDOTHELIOMAS): THEIR SOURCE, AND FAVOURED SEATS OF ORIGIN

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              Movement disorders caused by brain tumours.

              Movement disorders are uncommon presenting features of brain tumours. Early recognition of such lesions is important to arrest further deficit. We treated seven patients with movement disorders secondary to brain tumours over a period of seven years. Only two of these were intrinsic thalamic tumours (astrocytomas) while the rest were extrinsic tumours. The intrinsic tumours were accompanied by hemichorea. Among the extrinsic tumours, there was one pituitary macroadenoma with hemiballismus and four meningiomas with parkinsonism. Symptoms were unilateral in all patients except one with anterior third falcine meningioma who had bilateral rest tremors. There was relief in movement disorders observed after surgery. Imaging by computed tomography or magnetic resonance imaging is mandatory in the evaluation of movement disorders, especially if the presentation is atypical, unilateral and/or accompanied by long tract signs.
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                Author and article information

                Journal
                J Neurosci Rural Pract
                J Neurosci Rural Pract
                JNRP
                Journal of Neurosciences in Rural Practice
                Medknow Publications & Media Pvt Ltd (India )
                0976-3147
                0976-3155
                Jul-Sep 2014
                : 5
                : 3
                : 290-292
                Affiliations
                [1] Parkinson's Clinic of Eastern Toronto, Canada
                [1 ] Department of Biological Sciences, University of Toronto Scarborough Campus, Toronto, Canada
                [2 ] Department of Biological Sciences, McMaster University, Hamilton, Canada
                Author notes
                Address for correspondence: Dr. Abdul Qayyum Rana, Rana, 111-1371 Neilson Road, Toronto, Ontario, Canada -M1B 4Z8. E-mail: ranaaq@ 123456yahoo.com
                Article
                JNRP-5-290
                10.4103/0976-3147.133611
                4078622
                25002777
                0e1e3319-9442-4e51-8062-45948a90d696
                Copyright: © Journal of Neurosciences in Rural Practice

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Case Report

                Neurosciences
                dystonia,frontal lobe,hemichorea,meningioma
                Neurosciences
                dystonia, frontal lobe, hemichorea, meningioma

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