Background: Atypical meningiomas (WHO grade II) behave more aggressively than benign variants, with an increased frequency of recurrence and local brain invasion. However, distant extracranial spread is extremely rare. We present a case of metastatic atypical meningioma in a 32-year-old patient.
Case Presentation: A 32-year-old man presented with progressive right-sided weakness, headaches, and seizures. Clinical examination revealed a non-tender paramedian scalp swelling with normal overlying skin. Neuroimaging demonstrated a heterogeneous right frontal parafalcine extra-axial lesion with haemorrhagic components, vasogenic oedema, mass effect, and transosseous extension with calvarial erosion. A second smaller lesion was identified in the left temporal region with similar bone erosion. Computed tomography of the chest revealed multiple pulmonary nodules consistent with metastases. Histopathological evaluation of both brain and lung biopsy specimens demonstrated an atypical (fibroblastic) meningioma. While awaiting surgical intervention, the patient developed a massive intratumoral haemorrhage and multiple additional intracranial lesions within two months of diagnosis and subsequently died on admission.
Conclusion: Although meningiomas are predominantly benign, atypical (WHO grade II) meningiomas may present with multifocal intracranial disease, distant metastases, intratumoral haemorrhage, and calvarial bone erosion, as demonstrated in this case. Early diagnosis and timely surgical and adjuvant therapy are essential to reduce associated morbidity and mortality.