Case of the month: 11 year old European Shorthair cat. Restless and has problems keeping her balance.
Signalment and anamnesis
- 11 year old, female, neutered European Shorthair cat.
- Lately very restless and has problems keeping her balance
- Falls on her side
For further clarification, an MRI of the skull was performed:
T1 w native axial
T1 w contrast axial
T2 w axial
T2 w sagittal
MRI findings
- A large, relatively well demarcated extraaxial-intradural mass measuring approximately 1.5 x 1 cm is visible in the right parietal lobe
- The mass is hyperintense in the T2-weighted sequences and isointense in the native T1-weighted sequence
- The mass has broad-based contact with the neighboring dura and is surrounded by hyperintense material in the fluid-sensitive sequences, which is not completely suppressed in the FLAIR sequence
- The T1w post-gadolinium sequence shows significant and homogeneous enhancement of the mass with a dural tail extending into the falx cerebri and peripheral dura
- The mass and the surrounding fluid cause a mass effect in the brain, leading to compression and atrophy of the right hemisphere. This also leads to dilatation of the left ventricular system, a shift of the midline to the left, subfalcine herniation to the left, transtentorial herniation of the cerebrum and herniation of the cerebellum into the foramen magnum
- The overlying calvarium is hyperostotic/thickened
Diagnosis
- Extraaxial-intradural mass at the level of the right parietal lobe, surrounded by fluid (probably epidural hematoma), with pronounced mass effect on the brain; most likely neoplastic (meningioma, less likely lymphoma or granular cell tumor)
Outcome
- Surgery and histopathology confirmed a meningioma
Discussion
- Meningiomas are the most common primary brain tumors in cats, with a prevalence of 56% to 69%
- They are extra-axial and supratentorial, and develop from the dura mater, pia mater or subarachnoid space
- The connection to the dura or leptomeninges can be broad (= sessile), narrow (= pedunculated) or total (= meningioma en plaque)
- Multiple intracranial involvement may occur (14%-17%)
- Typical localizations are rostral to the tentorium, over the cerebral convexities and in the 3rd ventricle
- Meningiomas are observed more frequently in young cats with mucopolysaccharidosis type I
- In cats, these are benign and expansively growing tumors
- They are divided into several histologic types, including meningoepithelial, fibroblastic, transient, psammomatous, angioblastic, papillary, granular cell, myxoid, and anaplastic meningiomas, with the meningoepithelial or psammomatous types being the most common (source: vsso.org/brain-tumors-feline)
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Many thanks to Dr. ECVDI Thorsten Rick for this interesting case report
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