Clinical and radiological presentation of meningiomas

The purpose is to analyze the clinical and radiological presentation of meningiomas in an Indian population in a tertiary eye care institute in South India.

A total of 15 patients with intraorbital and intracranial meningioma presented to our neuro-ophthalmology clinic over 4 months. These cases of meningioma presented primarily to us with ophthalmic features and were diagnosed by us. Complete neuro-ophthalmic evaluation, including ocular examination, fundus, color vision, visual field, cranial nerve examination, was performed for each case and neuroimaging in the form of MRI brain with orbit with contrast. Clinical presentation of each case and site and extension of meningioma in neuroimaging was analyzed.

Among 15 patients, age range was from 26-72 years, with mean age of 56 years. A total of 27% of patients were male, and 73% were female. A total of nine out of 15 cases were histologically proven. Chiasmal compression was observed on neuroimaging in 53% of patients. A total of 10 patients (66.67%) presented with complaints of defective vision, and five patients (33.33%) had double vision as their presenting symptom. Clinical examination revealed signs of sixth cranial nerve involvement in 20%, multiple cranial nerve paresis in 20%, and third cranial nerve palsy in 13%. A total of 47% of patients did not have any cranial nerve involvement. Visual field examination revealed homonymous hemianopia in 13% of patients. On fundus examination, 40% had bilateral optic atrophy, and 7% presented with papilledema. Visual field defects were documented and corelated with location of meningioma.

Our study emphasizes the role of ophthalmologists in early detection of meningioma as many patients present first with subtle ophthalmological signs and symptoms before developing neurological symptoms.