Atypical symptoms from a small occipital meningioma: A case report

Meningiomas are typically slow-growing benign intracranial tumors, and symptomatic lesions smaller than 2 cm are uncommon, particularly in immunosuppressed patients, in whom primary central nervous system lymphoma may pose a diagnostic challenge.

We report the case of a 39-year-old woman with a history of renal transplantation on immunosuppressive therapy who presented with recurrent headaches, bilateral visual blurring, visual illusions, and later generalized seizures. Ophthalmological assessment revealed a left homonymous hemianopsia. Brain magnetic resonance imaging (MRI) demonstrated a small (1 cm) right occipital extra-axial lesion suggestive of meningioma. Because of her immunosuppressed status, cerebral lymphoma was also considered, since it has a similar morphology on MRI. A 5-day high-dose corticosteroid trial did not modify the lesion, supporting the diagnosis of meningioma.

This case highlights the diagnostic challenges posed by atypical occipital meningiomas and emphasizes that even very small lesions may produce substantial neurological and neuropsychiatric manifestations.