title: Cerebrospinal fluid dissemination of anaplastic intraventricular meningioma: report of a case presenting with progressive brainstem dysfunction and multiple cranial nerve palsies.
abstract: BACKGROUND
  It is extremely rare to see cerebrospinal fluid dissemination of intraventricular meningioma, particularly with the development of acute, progressive brainstem/cerebellar dysfunction with an absence of mass formation in the corresponding anatomical sites.
  
  
  METHODS
  An 81-year-old man was admitted because of double vision, right facial nerve palsy and truncal ataxia. Brain magnetic resonance imaging showed normal findings except for a tumor mass in the left lateral ventricle, which had been noted over 6 months previously. The patient developed hiccups, hyperventilation, and drowsiness, which worsened progressively, and did not respond to corticosteroid or intraventricular immunoglobulin therapy. Cerebrospinal fluid study revealed a mild elevation of protein, and cytology was negative. The patient died and an autopsy was performed. Postmortem investigation disclosed a malignant transformation of benign fibroid meningioma with cerebrospinal fluid dissemination of the malignant cells, diversely involving the surface of brainstem, cerebellum, and spinal cords, secondarily resulting in extensive ischemia in the brain parenchyma by vessel occlusion.
  
  
  CONCLUSIONS
  If a patient with an intraventricular tumor develops acute, progressive neurological symptoms, the possibility that it is be caused by cerebrospinal fluid dissemination of tumor cells, after malignant transformation, should be considered.
authors.affiliation: Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerimaku, Tokyo, 177-8521, Japan. mtfujima@juntendo.ac.jp.|Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyouku, Tokyo, 113-8431, Japan. mtfujima@juntendo.ac.jp.|, Postal Address: 2-1-1 Hongo, Bunkyouku, Tokyo, 113-8431, Japan. mtfujima@juntendo.ac.jp.
authors.forename: Motoki
authors.initials: M
authors.lastname: Fujimaki
authors.affiliation: Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerimaku, Tokyo, 177-8521, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Takanashi
authors.affiliation: Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerimaku, Tokyo, 177-8521, Japan.|Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyouku, Tokyo, 113-8431, Japan.
authors.forename: Manami
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerimaku, Tokyo, 177-8521, Japan.
authors.forename: Kei-ichiro
authors.initials: K
authors.lastname: Wada
authors.affiliation: Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerimaku, Tokyo, 177-8521, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Machida
authors.affiliation: Department of Neurosurgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyouku, Tokyo, 113-8431, Japan.
authors.forename: Akihide
authors.initials: A
authors.lastname: Kondo
authors.affiliation: Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyouku, Tokyo, 113-8431, Japan.
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Hattori
authors.affiliation: Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerimaku, Tokyo, 177-8521, Japan.
authors.forename: Hideto
authors.initials: H
authors.lastname: Miwa
mesh_terms: D000369:Aged, 80 and over; D001927:Brain Diseases / Q000473:pathology*; D001933:Brain Stem / Q000473:pathology; D003389:Cranial Nerve Diseases / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology*; D008579:Meningioma / Q000473:pathology*
keywords: Anaplastic meningioma; Brainstem dysfunction; Cerebrospinal fluid dissemination; Multiple cranial nerve palsies