Disclosures: Muhammad S. Rizwan, DO: No financial relationships or conflicts of interest

Case Diagnosis: 52-year-old female presenting with recurrence of meningioma who underwent right craniotomy and resection and developed worsening left-sided paresthesia and weakness

Case Description: A 52-year-old female with history of meningioma, intracranial hemorrhage, and CVA presented with intermittent paresthesia of the left arm. She underwent right parietal craniotomy and resection for a meningioma one year prior. MRI demonstrated increase in size of a recurrent meningioma with mass effect on the adjacent parenchyma with edema. The patient underwent right craniotomy and resection of the recurring tumor. She was subsequently admitted to acute inpatient rehabilitation.

Setting: Tertiary Care Hospital, Acute Inpatient Rehabilitation Unit

Assessment/Results: Following the procedure, she developed increased left-sided paresthesia and weakness. During her stay she made improvements in lower extremity strength, but upper extremity weakness and left-sided paresthesia persisted.

Discussion: Meningiomas are some of the most common types of brain tumors with contributing factors including age, race, and history of ionizing radiation. They are a component of many familial tumor syndromes and diseases including Neurofibromatosis type 2, MEN type 1, and Von Hippel-Lindau. Patients with complete resection of meningioma present with less than 30% chance of recurrence within the first few years. Our patient presented with rapid recurrence and worsening symptoms post-craniotomy and resection. Rehabilitative management of recurrent meningioma requires observation of possible post-operative complications including cerebral edema, seizures, and neurologic dysfunction. Neurologic symptoms following surgery typically decrease within the few days, but our patient demonstrated little improvement in upper extremity strength and paresthesia.

Conclusion: Rehabilitation in recurring meningioma status post craniotomy has not been well studied or documented. We highlight a unique case of rapid recurrence with worsening symptoms post-resection. It is important to recognize the neurologic complications of these procedures as they limit the patient’s rehabilitative capabilities. Special attention to these complications need to be given in order to prevent worsening functional decline.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/rapidly-recurring-meningioma-with-worsening-weakness-and-paresthesia-post-craniotomy-and-resection-a-case-report/