A Misleading Cystic Brain Lesion: An Uncommon Presentation of Meningioma

Cystic meningiomas are an uncommon presentation that may pose diagnostic challenges due to their atypical radiological features, frequently mimicking other cystic intracranial neoplasms. We report the case of a 40-year-old woman who presented with recurrent generalized tonic-clonic seizures, beginning in late pregnancy and the postpartum period, followed by progressive headaches and urinary incontinence. Neurological examination revealed psychomotor slowing, right-sided hemiparesis, and signs consistent with an upper motor neuron lesion. Neuroimaging demonstrated a well-circumscribed left frontoparietal extra-axial mass with a predominant cystic component, an enhancing mural nodule, significant mass effect, and midline shift, initially suggestive of a glial tumor. The patient underwent gross total surgical resection. Histopathological analysis confirmed a meningothelial meningioma with cystic features. Postoperatively, the patient showed clinical improvement without new neurological deficits. This case highlights the importance of considering cystic meningioma in the differential diagnosis of cystic brain lesions, particularly when imaging findings are atypical. Early recognition and appropriate surgical management are essential to achieve favorable clinical outcomes.