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Cranio-cervical junction meningiomas without hydrocephalus presenting solely with syncope: report of two cases.
World Neurosurg. 2018 Mar 15;:
Authors: Champagne PO, Bojanowski MW
Abstract
OBJECTIVE: To our knowledge, there have not been any reported cases of a meningioma of the cranio-cervical region presenting solely with syncope as its initial symptom. Only one case of meningioma presenting with syncope has been published, but it was associated with hydrocephalus. We report two cases of syncope caused by a cranio-cervical junction meningioma, with syncope being the sole presenting symptom and without hydrocephalus. We discuss the possible pathophysiology as well as the clinical relevance of this type of presentation.
METHODS: We reviewed the charts, operative details, and imagery of 2 cases of meningioma in the region of the cranio-cervical junction, with syncope as their sole presenting feature. We also reviewed the literature.
RESULTS: In one case the syncope occurred spontaneously. In the other, it occurred during a Valsalva maneuver. Both meningiomas were surgically removed via a retro-mastoid approach. There was no recurrence of syncope following surgery. Following a literature review, we found one case of posterior fossa meningioma presenting with syncope, but hydrocephalus was also present.
CONCLUSION: Syncope can be the sole manifestation of a meningioma of the cranio-cervical junction. Such syncopes are a consequence of transient dysfunction of the autonomous pathways in the medulla and/or of the medulla's output. In the absence of other causes of syncope, a meningioma in this region, even in the absence of hydrocephalus, should not be considered as fortuitous, but rather as the actual cause of syncope. Recognizing this possibility offers the potential for proper diagnosis and appropriate treatment of the syncope.
PMID: 29551725 [PubMed - as supplied by publisher]
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