Falcine Meningioma – Dural Tail — SCE Neurology MCQ

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EasyNeuro-oncologyFalcine Meningioma – Dural TailSCE Neurology

A 45-year-old woman presents with a 2-week history of progressive headache and visual disturbance. MRI brain shows a well-circumscribed extra-axial mass arising from the falx cerebri with a dural tail, homogeneously enhancing with gadolinium. It compresses the adjacent parasagittal cortex bilaterally. What is the most likely diagnosis?

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Correct answer: B — Falcine meningioma

A homogeneously enhancing extra-axial mass arising from the falx cerebri with a dural tail is pathognomonic for a meningioma. Falcine meningiomas arise from the falx and can compress the parasagittal cortex bilaterally, causing bilateral leg weakness (parasagittal syndrome). The dural tail sign (thickened enhancing dura adjacent to the mass) is characteristic of meningiomas. Treatment is surgical resection if symptomatic. A: GBM is intra-axial with ring enhancement. C: Epidermoid cysts do not enhance. D: Abscess has ring enhancement with restricted diffusion. E: Metastases are typically intra-axial.

Reference: NICE NG99 Brain Tumours (2021); WHO CNS Tumour Classification