Foramen magnum meningioma: Dysphagia of atypical etiology.
BACKGROUND
We present a case of a foramen magnum meningioma that highlights the importance of the neurologic exam when evaluating a patient with dysphagia. A 58-year-old woman presented with an 18-month history of progressive dysphagia, chronic cough and 30-pound weight loss. Prior gastroenterologic and laryngologic workup was unrevealing.


RESULTS
Her neurologic examination revealed an absent gag reflex, decreased sensation to light touch on bilateral distal extremities, hyperreflexia, and tandem gait instability. Repeat esophagogastroduodenoscopy was normal, whereas laryngoscopy and video fluoroscopy revealed marked hypopharyngeal dysfunction. Brain magnetic resonance imaging demonstrated a 3.1 x 2.7 x 2.9 cm foramen magnum mass consistent with meningioma. The patient underwent neurosurgical resection of her mass with near complete resolution of her neurologic symptoms. Pathology confirmed diagnosis of a WHO grade I meningothelial meningioma.


CONCLUSIONS
CNS pathology is an uncommon but impressive cause of dysphagia. Our case demonstrates the importance of a thorough neurologic survey when evaluating such a patient.
Tsao
Gabriel J
GJ
School of Medicine, Stanford University, Stanford, CA, USA. gtsao@stanford.edu
Tsang
Matthew W
MW
Mobley
Bret C
BC
Cheng
Walter W
WW
D003680:Deglutition Disorders / Q000209:etiology*; D005260:Female; D005539:Foramen Magnum / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008577:Meningeal Neoplasms / Q000150:complications*; D008579:Meningioma / Q000150:complications*; D008875:Middle Aged