Cervical meningioma causing thromboembolic ischemic stroke via vertebral artery compression

Background Spinal Meningiomas account for 38% of primary central nervous system tumors and 25% of intradural extramedullary spinal neoplasms. As a subcategory, spinal meningiomas themselves account for 3% of all central nervous system meningiomas. These slow‐growing, benign lesions appear most commonly present in women and remain asymptomatic. On occasion, however, cervical meningiomas may become symptomatic due to nerve root or spinal cord compression. Here we present a case of a 61‐year‐old male who experienced an ischemic stroke due to external compression of the vertebral artery due to the spinal meningioma. Methods A 61‐year‐old man presented to the Emergency Department with acute onset dizziness, nausea, vomiting, chest pain, gait imbalance, and confusion. His examination showed facial droop, dysarthria and dysphagia. MRI of the brain and CTA of the head revealed an acute right vertebral artery thrombosis and ischemic changes involving the right cerebellar hemisphere and right medulla. An intradural, extramedullary mass consistent with a meningioma was identified compressing the right vertebral artery at the spinal C1‐C2 level. This neoplasm, which also caused asymptomatic spinal cord compression without MR parenchymal signal changes was felt to have been responsible for arterial thrombosis and subsequent thromboembolic ischemic stroke. Results Patient management included 4000 units of intravenous heparin load followed by heparin infusion with goal PTT 50‐70, along with 300 mg of rectal aspirin. The patient opted to forego tumor resection until he recovered from the stroke. More than a month post‐stroke, the patient's neurologic examination revealed mild dysarthria and dysphagia. Conclusions This case describes the rare instance of a cervical, intradural, extramedullary tumor (presumed to be a meningioma) presenting as a vertebral artery distribution thromboembolic cerebellar stroke secondary to external vascular compression and arterial occlusion. Key Words Spinal meningioma, ischemic stroke, vertebral artery thrombosis