AlSabea N, Syeda S, Gubran M, Gibatova V, Sharma R, Aswani A. Atypical presentation of a large posterior falx meningioma involving the parafalcine region in a 78-year-female: A case report. World J Clin Cases 2025; 13(25): 108429 [DOI: 10.12998/wjcc.v13.i25.108429]
Corresponding Author of This Article
Nadeem AlSabea, MD, Department of Internal Medicine, Mt. Sinai Hospital, 1500 S Fairfield Ave, Chicago, IL 60608, United States. nadeemalsabea88@gmail.com
Research Domain of This Article
Medicine, General & Internal
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nadeem AlSabea, Samar Syeda, Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL 60608, United States
Marina Gubran, Viktoriya Gibatova, Rahul Sharma, Anjiya Aswani, Department of Internal Medicine, Ross University, Chicago, IL 60608, United States
Co-first authors: Nadeem AlSabea and Samar Syeda.
Author contributions: Gubran, M and Gibatova V designed paper; Gubran M, Gibatova V, and Sharma R analyzed data; Aswani A and Gibatova V performed research; Gubran M, Aswani A, Gibatova V, and Sharma R wrote the paper; Gubran M performed paper topics research; Aswani A, Gibatova V, AlSabea N, and Syeda S contributed new reagents or analytic tools; AlSabea N and Syeda S designed paper structure. All authors actively participated in the preparation of this manuscript, including the acquisition of essential clinical data, and the editing and proofreading of content to ensure its clinical accuracy and relevance. All authors have reviewed and approved the final version of the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and accompanying images.
Conflict-of-interest statement: The authors have no conflict of interest to declare. All co-authors have seen and agree with the contents of the manuscripts and there is no financial interest to report. We certify that the submission is original work and is under review at any other publication.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016) and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nadeem AlSabea, MD, Department of Internal Medicine, Mt. Sinai Hospital, 1500 S Fairfield Ave, Chicago, IL 60608, United States. nadeemalsabea88@gmail.com
Received: April 14, 2025 Revised: April 27, 2025 Accepted: May 27, 2025 Published online: September 6, 2025 Processing time: 84 Days and 3.4 Hours
Abstract
BACKGROUND
Meningiomas represent the most common primary intracranial tumor in adults. The majority of meningiomas are indolent, benign, and sporadic in nature. The incidence of meningiomas is directly proportional to the age, peaking around 65 years. The presenting symptomatology of intracranial meningiomas is mainly dependent on their anatomical location, as with the majority of brain tumors. Surgical resection and radiation therapy remain the treatment modality for meningiomas of all grades.
CASE SUMMARY
We present a case describing a 78-year-old female who came in following a ground level fall. The primary assessment was notable for a history of similar recurrent falls and subtle left-sided peripheral visual field loss. Further neurological examination was otherwise largely unremarkable. A computed tomography scan of the head revealed a large extra-axial mass located along the posterior aspect of the falx. Follow-up magnetic resonance imaging confirmed a lesion measuring around 6.6 cm × 4.2 cm × 5.5 cm. A partial surgical resection of the right-sided portion of the lesion was performed. Complete resection was limited by insufficient visualization and challenges with hemostatic control of the left parafalcine region. Further histopathological analysis confirmed a fibrous meningioma with focal necrosis, consistent with World Health Organization Grade 2 classification. She was subsequently scheduled for outpatient follow-up to assess the residual tumor management.
CONCLUSION
This case highlights the importance of maintaining a high index of suspicion for intracranial pathology in elderly patients with nonspecific presentation.
Core Tip: This case report presents an unusual clinical scenario describing a 78-year-old female who was admitted after a ground-level fall. Neuroimaging unexpectedly revealed a large intracranial mass, measuring over 6 cm at its greatest and situated in the posterior falx. It was associated with extensive vasogenic edema and mass effect. This imaging finding was remarkable given the minimal symptomology of the patient's presentation with no significant neurological deficits. Only a subtotal resection was feasible in our case. Histopathological analysis confirmed the diagnosis of fibrous meningioma with areas of focal necrosis. Other info: (1) Informed consent was obtained; (2) Does not apply to case reports; (3) Manuscript has been reviewed multiple times; and (4) Fibrinous meningioma represents a rare and under-characterized histological variant ofmeningioma, with distinct pathological features such as extensive fibrin deposition and reduced tumor cellularity. This case does not exemplify a new treatment or new mechanism research. The case has an educational value regarding rare occurrence of subtype of meningiomas.
