A rare presentation of extra-axial supratentorial ependymoma with subdural hematoma mimicking a parasagittal meningioma

• Published in: Brain & spine Vol. 3; p. 101715
• Main Authors: Bohara, Sandeep, Shrestha, Sushan, Thapa, Amit
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-01-2023; Elsevier
• Subjects: Case Report; Meningioma; Subdural hematoma; Supratentorial ependymoma; Supratentorial ependymoma; Meningioma; Subdural hematoma
• ISSN: 2772-5294; 2772-5294
• DOI: 10.1016/j.bas.2023.101715

Primary extra-axial ependymomas, though rare, the majority of such lesions are identified as WHO grade III ependymomas. These ependymomas may mimick a meningioma on radiological investigations which can be confirmed by histopathology.
We show in this case report a rare presentation of extra-axial supratentorial ependymoma with concomitant subdural hematoma mimicking a parasagittal meningioma.
A 59 years lady with no known comorbidities presented with weakness of right half of body and decreased speech for 2 days. She was aphasic. Contrast MRI brain revealed an extra-axial dural-based homogenously enhancing lesion in the left anterior 1/3rd parasagittal area with left frontotemporoparietal chronic subdural hematoma. With a provisional diagnosis of meningioma, the patient was subjected to bifrontal open-book craniotomy with gross total excision of lesion with periosteal graft duraplasty and acrylic cranioplasty. Left sided frontotemporal subacute SDH with thin greenish yellow membrane was present. In post operative period, patient quickly became E4V5M6 with power of 4/5 in the right half of body which was same as compared to the preoperative period.
The biopsy of the mass, however, revealed features suggestive of extra-axial supratentorial ependymoma (WHO Grade III). Immunohistochemistry supported the diagnosis of supratentorial ependymoma, NOS. The patient was then referred for further chemoradiation.
We report the first case of extra-axial supratentorial ependymoma mimicking a parasagittal meningioma occurring with adjacent subdural hematoma. Clinical and imaging background along with a complete pathological examination with immunohistochemical study is essential to confirm the diagnosis of rare brain tumours.
•Primary extra-axial ependymomas, though rare, the majority of such lesions are identified as WHO grade III ependymomas.•A 59 years lady with no known comorbidities presented with weakness of right half of body and decreased speech for 2 days. Contrast MRI brain revealed an extra-axial dural-based homogenously enhancing lesion in the left anterior 1/3rd parasagittal area ​with chronic subdural hematoma.•With a provisional diagnosis of parasagittal meningioma the patient was subjected to gross total excision of lesion. Left sided frontotemporal subacute SDH with thin greenish yellow membrane was also present.•However, biopsy of the mass revealed features suggestive of extra-axial supratentorial ependymoma (WHO Grade III). Immunohistochemistry supported the diagnosis of supratentorial ependymoma, NOS. The patient was then referred for further chemoradiation.•Thus, clinical and imaging background along with a complete pathological examination with immunohistochemical study is essential to confirm the diagnosis of rare brain tumours.