Elderly patient with a calcified upper cervical meningioma acutely worsened by head trauma

Only 1-5% of all spinal meningiomas (SMs) are calcified. These tumors typically grow slowly and remain asymptomatic for prolonged periods of time. They are only rarely acute and present with neurological deterioration precipitated by trauma. Here, an 81-year-old female with a calcified upper cervical meningioma presented with acute paralysis following just minor head trauma.

An 81-year-old female developed the rapid onset of quadriparesis following minor head trauma. The brain cervical magnetic resonance imaging demonstrated a calcified intradural extramedullary lesion at the C2-C3 level, causing significant spinal cord compression, accompanied by a subtle intramedullary high-intensity signal at C2-likely reflecting a spinal cord injury. The computed tomography confirmed a hyperdense mass with circumferential calcification at the C2-C3 level. Surgery, performed 6 days later, consisted of a C2- C3 hemilaminectomy. Intraoperatively, the firm/grayish tumor was completely removed. The histopathological examination confirmed a psammomatous meningioma. Postoperatively, motor function improved immediately, and the patient achieved independent ambulation by postoperative day 14.

Calcified SMs present diagnostic and surgical challenges due to firm adhesion to surrounding neural and dural structures. This case highlights that even minor trauma can precipitate neurological deterioration due to calcified upper cervical meningiomas.