1504 - Not so benign meningioma: a case study of rehabilitation after WHO grade III meningioma surgical resection

Case Diagnosis: Cognitive impairment after surgical resection of WHO grade III meningioma

Case Description: 76-year-old female presented with 4 months of left eye pain with swelling and vision changes, increased fatigue, weight gain, and hypersomnia. MRI revealed intranasal mass with invasion into the left orbit. Initial biopsy revealed World Health Organization (WHO) grade I meningioma. A few weeks later, her family reported cognitive changes including confusion, impulsiveness, forgetfulness, increased appetite, and desire for alcohol. Personality changes were suspected to be secondary to mass effect of the meningioma. Therefore, the patient underwent embolization and two-part partial resection of the neoplasm. Pathology from these resections revealed meningioma grade III. The patient was then admitted to acute inpatient rehabilitation for generalized weakness and cognitive dysfunction including significant distractibility, poor attention, and poor effort. During her rehabilitation, the team focused on optimizing sleep hygiene, utilizing amantadine for neurostimulation, and collaborating with speech-language pathology, neuropsychology, physical and occupational therapy in order to maximize cognitive rehabilitation.

Discussions: WHO grade III meningiomas account for less than 5% of documented meningiomas and are considered malignant. Malignant meningiomas pose a greater risk of recurrence and may require more aggressive treatment including surgical resection and radiation. Post-operative rehabilitation is complicated by extremity weakness and neurocognitive deficits. Cognitive impairment in the form of apathy, disinterest, and lethargy further detracts from participation in physical and occupational therapies. Efforts to optimize sleep hygiene, intensive cognitive rehabilitation, and neurostimulant agents should be considered in order to improve overall rehabilitation.

Conclusions: This case illustrates the changes in cognitive function due to the mass effect of meningioma growth and the challenges of cognitive decline after surgical resection. With the risk of recurrence, especially after partial resection without radiation, rehabilitation should prioritize cognitive recovery in conjunction with physical activity to improve quality of life.