Petroclival Meningioma Accompanying Posterior Cerebral Artery Infarction.

permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Meningiomas are one of the most common brain tumors. Because of their slowly progressive nature, they are usually benign and are asymptomatic throughout the patient's life. 1 Pet-roclival meningioma usually originates from the petrous tip medial to the trigeminal nerve. By virtue of the location, diverse neurological deficits due to the compression of cranial nerves have been reported. 2 However, compression of arteries that cause ischemic symptoms is rare. 3 Here, we report a case of petroclival meningioma accompanying posterior cerebral artery (PCA) infarction. A 75-year-old woman with hypertension visited the emergency department owing to left homonymous hemianopia, which started 3 days prior. Magnetic resonance imaging revealed acute infarction in the right PCA territory (Figure 1A) and occlusion of the P1 portion of the right PCA (Figure 1B). Six years prior to this presentation, the patient was diagnosed with meningioma originating from the petroclival area (Figure 1C). The extent of meningioma included the internal auditory canal, right cavernous sinus, and Meckel's cave. The patient received four courses of radiotherapy during the first year after the diagnosis. However, no change was observed in the size of the meningioma. No other significant stenoses at the intracranial and extra-cranial arteries were observed on magnetic resonance angiog-raphy. Extensive cardiac workups, including Holter monitoring , and transthoracic and transesophageal echocardiography, did not reveal any intracardiac embolic source. A week after symptom onset, follow-up computed tomographic angiogra-phy (CTA) was performed. The PCA was not recanalized. Compared with the CTA performed 5 months before the in-farction (Figure 1D), the follow-up CTA revealed that the PCA was compressed between the crus cerebri, hypothala-mus, and the slightly enlarged meningioma (arrowhead) in the perimesencephalic cistern (Figure 1E). Even when the arteries are totally encased inside the menin-gioma, blood flows are usually maintained. 4 The slow growth, less-invasive nature, and insufficient external force of the me-ningioma, which may bounce the artery rather than compress it, may explain the low occurrence rate of ischemic symptom. However, a few cases of internal carotid artery (ICA) occlu-sion due to compression by a meningioma were reported. 3 At the level of the skull base, ICA is attached to the dura mater, its flexibility is restricted, and it may be prone to compression. 3 A case with anterior cerebral artery (ACA) infarction caused by a small planum sphenoidale meningioma …