Meningioma And Stroke: Understanding The Link

Meningiomas are the most common benign brain tumours in adults. They are usually benign, slow-growing, and arise from the arachnoid cells of the leptomeninges. While seizures are a common presenting symptom, meningiomas can also cause strokes, albeit rarely. This is due to the tumour causing vascular compression, vascular infiltration, or coagulation disorders. The incidence of meningioma-related strokes is estimated to be between 0.13% and 0.38%.

Can meningioma cause stroke in young people?

Meningiomas are tumours that form in the meninges, which are the layers of tissue that cover and protect the brain and spinal cord. They are usually benign, but they can sometimes be cancerous. They are the most common type of brain tumour and are more common in adults than in children, with the average age at diagnosis being 66 years. However, they can still develop in younger people.

Meningiomas tend to grow slowly and inward, and they may grow quite large before they are diagnosed. Even benign meningiomas can become large enough to be life-threatening if they compress and affect areas of the brain. They can cause seizures, nausea and vomiting, changes in vision, behavioural changes, overactive reflexes, muscle weakness, and paralysis, among other symptoms.

While meningiomas are a rare cause of stroke, it is possible for them to lead to strokes in young people. A 2013 case study reported on a 30-year-old woman who experienced a stroke due to a sphenoid wing meningioma. Another case study from 2023 described a 36-year-old woman who presented with an ischemic stroke caused by a left medial sphenoid wing meningioma. In both cases, the patients experienced severe headaches, unconsciousness, and hemiplegia.

Strokes due to meningiomas are a highly rare clinical occurrence but should be given serious consideration, especially in young patients. The slow-growing nature of meningiomas means that stroke symptoms tend to develop over days, weeks, or months rather than hours or minutes. However, in rare cases, meningiomas can lead to occlusion of arteries, such as the middle cerebral artery, resulting in cerebral infarction and stroke-like symptoms.

What are the risk factors for meningioma?

Meningioma risk factors are certain conditions and characteristics that increase the likelihood of developing this type of brain tumour. While some risk factors are directly and indisputably linked to meningioma, others are loosely correlated at best. For example, being female is considered a risk factor because most patients are women, but this doesn't mean that all women should be overly concerned about developing a brain tumour.

• Exposure to ionising radiation, such as radiation therapy to the head or neck.
• Undergoing hormone replacement therapy. Meningiomas have receptors for hormones like estrogen, progesterone, and androgen on their cell surfaces, and they tend to grow more quickly in pregnant women, whose bodies naturally produce high levels of these hormones.
• Neurofibromatosis type 2, a rare genetic disorder that predisposes individuals to certain benign tumours of the central nervous system, including meningiomas.

Other possible risk factors include:

• Head trauma.
• Long-term, frequent cell phone use.
• A history of epilepsy.
• Frequent lead exposure.
• Smoking.
• Being over the age of 60.

What are the symptoms of meningioma?

Meningiomas are the most common type of primary brain tumour, accounting for about 30% of all brain tumours. They originate in the meninges, the outer three layers of tissue between the skull and the brain, growing out of the middle layer, known as the arachnoid. They are slow-growing and may exist for years before being detected.

Meningioma symptoms, when they do occur, are often very subtle and start slowly as the tumour grows and presses on the brain or spinal cord. Depending on the meningioma's size and location, common symptoms may include:

• Seizures
• Weakness in the arms or legs
• Headaches
• Loss of smell
• Vision problems
• Hearing problems
• Facial problems
• Problems with balance and coordination
• Difficulty thinking and remembering

Less common symptoms include:

• Vomiting
• Unconsciousness
• Paralysis
• Anisocoria (one pupil larger than the other)

How is meningioma treated?

Meningioma is a primary central nervous system (CNS) tumour, which means it begins in the brain or spinal cord. It is the most common type of primary brain tumour, with around 50,000 cases per year. While most meningiomas are benign, around 20% are higher-grade tumours that do not respond well to treatment.

The first treatment for a malignant meningioma is surgery, if possible. The goal of surgery is to obtain a tissue sample to determine the tumour type and remove as much of the tumour as possible without causing further symptoms. However, surgery for meningioma is complex as it is a type of brain surgery, and a tumour in a bad position could mean a high likelihood of paralysis.

Following surgery, most people with atypical and anaplastic meningiomas receive additional treatments such as radiation or chemotherapy. Clinical trials may also be an option, testing new chemotherapy, targeted therapy, or immunotherapy drugs.

In cases where surgery is not possible, doctors may consider radiosurgery, which has been used in inoperable cavernous sinus meningiomas with internal carotid artery occlusion due to tumour infiltration.

In terms of prognosis, the five-year survival rate for high-grade meningioma is 63.5%. However, many factors can affect prognosis, including the patient's age, health, and response to treatment.

What is the long-term prognosis for meningioma?

The long-term prognosis for meningioma depends on several factors, including the size, location, and grade of the tumour, as well as the patient's age, overall health, and response to treatment.

Meningiomas are graded based on the characteristics of the tumour tissue, with Grade 1 being the most common and least aggressive, and Grade 3 being rare and cancerous. The grade of the tumour is a significant factor in determining the long-term prognosis. Grade 1 meningiomas are slow-growing, low-grade tumours, typically with a better long-term prognosis. Grade 2 meningiomas are mid-grade tumours with a higher chance of recurrence, while Grade 3 meningiomas are malignant and fast-growing.

The location of the tumour also plays a role in the long-term prognosis. Meningiomas that occur in the skull base region, particularly the sphenoid wing, can lead to serious complications if they compromise cerebral blood flow or exert pressure on critical structures. Additionally, the size of the tumour matters, as even benign meningiomas can grow large enough to become life-threatening if they compress nearby areas of the brain.

The patient's age and overall health are also important considerations. Meningiomas are more common in adults aged 65 or older, and the risk increases with age. Black people tend to have higher rates of meningioma than other ethnic groups, and females are more likely to develop meningiomas than males due to hormonal factors. However, malignant meningiomas are found more often in males.

The long-term prognosis for meningioma patients can vary widely. In general, the younger the patient, the better the prognosis. Surgical removal of the entire tumour can significantly improve the prognosis, but this may not always be possible due to the location of the tumour. Meningiomas can also recur after treatment, with the recurrence rate associated with the extent of surgical removal.

While meningiomas are typically slow-growing, they can still lead to serious complications and even death if left untreated. Therefore, early diagnosis and appropriate treatment are crucial for improving the long-term prognosis for meningioma patients.

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