Sudden Presentation of Intracranial Meningioma After Elective General Anesthesia

Abstract

A case of "silent" intracranial meningioma unmasked by narcosis is described. The diagnosis was made because of the patient's failure to wake up after elective general anesthesia for orthopaedic surgery. Factors leading to this complication and its management are discussed. Early computed tomography scan and antiedema therapy are strongly suggested for these patients.

Silent meningioma: a cause of quadriperesis in total knee arthroplasty

“…There are only a few reports of asymptomatic brain tumours complicating the postoperative course of nonneurosurgical patients. 4,10,11 Also, few reports of meningioma presenting as stroke in cardiac surgery. 12 The present case is of a meningioma manifested as stroke in post-operative period of TKA.…”

Post-operative accidental diagnosis of intra-cerebellar astrocytoma in an emergency appendicectomy case

“…In any case of prolonged recovery or delayed neurological deficit post-general anaesthesia, a silent brain tumour should be suspected after exclusion of the most common causes [ Figure 2 ]. [ 9 ] Brief neurological examination such as pupillary size, reactivity of the limbs to painful stimuli should be performed on every patient. Evaluation of prolonged post-anaesthetic coma should include a CT scan even in the absence of focal signs when no clear cause is evident.…”

Silent meningioma – a rare cause of stroke in post-cardiopulmonary bypass patients

“…The incidence increases with age [3] and many meningiomas remain clinically silent and do not require surgery. There are only a few reports of asymptomatic brain tumours complicating the postoperative course of non-neurosurgical patients [4–6]. …”

“…Predictors of stroke in patients undergoing cardiac surgery are well reported [4, 5] and are very helpful to identify high risk patients in whom management strategies can be altered accordingly. Preoperatively, our patient was totally asymptomatic in regards to any kind of brain tumour.…”

“…It can be due to a variety of factors ( Appendix ), but is most commonly caused by a relative overdosage of the anaesthetic agents [4, 6, 15]. Prolonged recovery should also raise high suspicion of a silent brain tumour after exclusion of other leading causes of delayed recovery [15].…”