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Dorsal Psammomatous Meningioma Revealed by Sciatica Case Report

Introduction: Meningiomas are benign tumors most localized in brain. Intraspinal 
meningiomas are rare and may have an intra or extradural topography. We report 
the case of a dorsal psammomatous meningioma revealed by sciatica. Case 
description: We present a 58-year-old female hospitalized for bilateral 
painful and disabling L5 sciatica rebellious to medical treatment and 
physiotherapy. At physical examination, she presented a lumbar spinal syndrome 
without root deficit. MRI (Magnetic Resonance Imaging) showed a borderline lumbar canal with a 
paramedian L4-L5 herniated disc. She undergone a first surgery a L4 decompressive 
laminectomy and there was no postoperative complications. The follow-up was marked by partial pain 
regression. Three months later, after a fall she presented low back pain and 
progressive worsening gait troubles. A MRI was realized and shown L3-L4, L4-L5 
duct narrowing. A second surgery a L3 and L5 decompressive laminectomy was 
performed. The postoperative follow up was characterized by the worsening of the motor deficit to 2/5 associated with brisk 
osteotendinous reflexes. A medullary MRI was realized, showing an intradural 
but extra-medullary compressive lesion facing D1-D2. The 
indication of tumor removal was made and complete resection was performed. She 
totally recovered from the deficit and the pain. The pathology report showed a 
psammomatous meningioma. Conclusion: This case report emphasizes the 
atypical clinical presentation of spinal meningiomas and the importance of a 
meticulous neurological examination to avoid misdiagnosis.