Rapid symptomatic and radiographic evolution after presumed spontaneous infarction of a meningioma

Meningiomas are extremely common benign extra-axial brain tumors. When meningiomas present clinically, they typically cause subacute symptoms such as headache. Rarely, meningiomas become acutely symptomatic due to tumor necrosis, which may occur spontaneously or as a result of global hypoperfusion. Here, we describe an elderly man who experienced a rapid subacute decline after meningioma infarction. Computed tomography and magnetic resonance imaging obtained in this case demonstrate the evolution of a benign-appearing meningioma into a ring-enhancing lesion with significant surrounding cerebral edema in <2 weeks. After the resection of a WHO grade 1 meningioma with central necrosis, the patient made a good clinical recovery.