Atypical symptoms from a small occipital meningioma: A case report

Background: Meningiomas are typically slow-growing benign intracranial tumors, and symptomatic lesions smaller than 2 cm are uncommon, particularly in immunosuppressed patients, in whom primary central nervous system lymphoma may pose a diagnostic challenge. Case Description: We report the case of a 39-year-old woman with a history of renal transplantation on immunosuppressive therapy who presented with recurrent headaches, bilateral visual blurring, visual illusions, and later generalized seizures. Ophthalmological assessment revealed a left homonymous hemianopsia. Brain magnetic resonance imaging (MRI) demonstrated a small (1 cm) right occipital extra-axial lesion suggestive of meningioma. Because of her immunosuppressed status, cerebral lymphoma was also considered, since it has a similar morphology on MRI. A 5-day high-dose corticosteroid trial did not modify the lesion, supporting the diagnosis of meningioma. Conclusion: This case highlights the diagnostic challenges posed by atypical occipital meningiomas and emphasizes that even very small lesions may produce substantial neurological and neuropsychiatric manifestations.