Hassan Mohamed Sheikh, Köksal Ayhan
Department of Neurology, Mogadishu Somali Turkish Training and Research Hospital.
Professor of Neurology, University of Health Sciences, Başakşehir Cam and Sakura City Hospital.
Ann Med Surg (Lond). 2023 May 25;85(7):3697-3700. doi: 10.1097/MS9.0000000000000928. eCollection 2023 Jul.
Cerebellopontine angle (CPA) meningioma is a slowly growing benign tumor of the brain that may compress adjacent neural structures. It has variable clinical presentations that progress very slowly depending on its growth pattern and associated mass effect. A sudden onset clinical presentation is unusual and should prompt consideration of other potential etiologies.
Here, the authors present a 66-year-old male patient with diabetes, hypertension, and hyperlipidemia who presented to the emergency department of our hospital with sudden onset walking difficulty (ataxia). On examination, the patient was fully conscious. There was no associated cranial nerve deficit, hearing loss, or focal/lateralizing weakness. All sensory modalities were intact. However, the patient had a gait impairment. Romberg and tandem gait tests were positive with the tendency to sway to the left. The patient was admitted with suspicion of acute cerebrovascular disease. The initial noncontrast brain computed tomography and subsequent diffusion MRI were inconclusive. A later brain MRI with contrast revealed a homogeneously contrast enhancing meningioma in the left CPA.
The differential diagnosis of sudden onset ataxia is broad and should include the assessment of a possible CPA lesion. Sudden onset ataxia by a CPA meningioma is very rare as meningiomas grow very slowly. A brain MRI with contrast is essential for its diagnosis.
Although stroke is the main cause of sudden onset ataxia in a patient with cerebrovascular risk factors, yet other less common causes may be found as in this case of CPA meningioma.
桥小脑角（CPA）脑膜瘤是一种生长缓慢的脑部良性肿瘤，可能会压迫相邻的神经结构。其临床表现多样，根据生长模式和相关的占位效应进展非常缓慢。突然起病的临床表现并不常见，应促使考虑其他潜在病因。
在此，作者介绍一名66岁男性患者，患有糖尿病、高血压和高脂血症，因突然出现行走困难（共济失调）到我院急诊科就诊。检查时，患者意识清醒。无相关的颅神经缺损、听力丧失或局灶性/定位性肌无力。所有感觉功能均正常。然而，患者存在步态障碍。闭目难立试验和直线行走试验阳性，有向左摇摆的倾向。患者因怀疑急性脑血管疾病入院。最初的脑部非增强计算机断层扫描及随后的扩散磁共振成像结果不明确。后来的脑部增强磁共振成像显示左侧桥小脑角有一个均匀强化的脑膜瘤。
突然起病的共济失调鉴别诊断范围广泛，应包括对可能的桥小脑角病变的评估。桥小脑角脑膜瘤导致的突然起病的共济失调非常罕见，因为脑膜瘤生长非常缓慢。脑部增强磁共振成像对其诊断至关重要。
虽然中风是有脑血管危险因素患者突然起病共济失调的主要原因，但如本例桥小脑角脑膜瘤这种其他较不常见的病因也可能被发现。
