A rare case of coexistence of meningioma and glioma in a single patient: A case report from Nepal

Introduction and importance: Primary brain tumors are less frequent as compared to metastatic brain tumors. Meningioma and glioma are common primary brain tumors. The patho-physiologies of meningioma and glioma are disparate. The concurrence of these two lesions in same patient is extremely rare, only few such cases are documented till now. Case presentation: We present a case of an elderly male presenting with sudden weakness of left limbs. He had weakness in his left limbs (muscle power was 4/5 and 4/5 respectively). There was no weakness in his right limbs. There was decreased sensation in his left hand and below left knee, while sensations of his right limbs were intact. Bilateral plantar reflex was down going. Bulk and tone of his limbs were normal. His higher mental function and cranial nerves were normal. There was no facial deviation. Cerebellar sign, meningeal irritation, clonus was absent. The rest of systemic examination findings were regular. CT scan and MRI of brain revealed right frontal meningioma and right parietal high-grade glioma. He underwent right temporoparietal craniotomy and excision of both tumors. Histopathological examination confirmed the diagnosis of fibrous meningioma and high-grade glial tumor. He was discharged in stable condition. Clinical discussion: This case demonstrates rare phenomenon of simultaneous occurrence of meningioma and glioma in the same patient without any known predisposing factors. The exact mechanism behind this phenomenon is unclear. Conclusion: Clinicians should be aware of the possibility of co-existence of multiple primary brain tumors with different histologies in same patient.