European Journal of Radiology Extra 55 (2005) 71–73 Cervical dumbbell meningioma and bilateral acoustic schwannoma in a patient with neurofibromatosis type 2 Ansari Mukhtar Alam a,* , Ibrahim Lutfi Shuaib a , Rudra Ghimire b a Advanced Medical and Dental Institute, Universiti Sains Malaysia, 11800 Pulau Pinang, Malaysia b Department of Radiology and Imaging, Tribhuvan University, Teaching Hospital, Maharajgunj, Kathmandu, Nepal Received 23 June 2005; received in revised form 4 July 2005; accepted 8 July 2005 Abstract Cervical meningiomas and schwannomas are relatively common neoplasms of the central nervous system but cervical dumbbell meningioma and bilateral schwannoma in the same patient in neurofibromatosis type 2 are rare. We report a case of a 16-year-old girl who presented with a history of slowness in performance for 1 year, decreasing weight for the last 7 months and weakness of the left lower limb for 6 months. There was no caf´ e-au-lait spot noted. MR imaging revealed a cervical extradural tumor with bilateral foraminal extension at the C4-5 and bilateral cerebellopontine angle tumors. A diagnosis of neurofibromatosis type 2 was made. The histopathological examination revealed meningioma. Follow up examination with magnetic resonance imaging (MRI) of the brain and spinal cord in a patient with neurofibromatosis type 2 should be performed to detect the recurrent tumours at these sites. © 2005 Elsevier Ireland Ltd. All rights reserved. Keywords: Dumbbell meningioma; Neurofibromatosis; Schwannoma; Magnetic resonance imaging 1. Case report A 16-year-old girl presented with a history of slowness in school performance for 1 year, a weight reduction of 9 kg within 7 months and weakness of the left lower limb for 6 months. The patient attended neurosurgical out patient department. Neurologic examination revealed up going left plantar and power of left lower extremity 3/5. MR imaging of the cervical spine was advised and it revealed an extradu- ral tumor with bilateral foraminal extension into the C4 and C5 with bilateral acoustic schwannomas. The MR imaging features were interpreted as cervical neurofibromatosis with bilateral acoustic schwannomas. The signal intensity of the tumor was equal to or slightly lower than that of spinal cord on both T1- and T2-weighted images and intravenous adminis- tration of gadolinium resulted in homogeneous enhancement of the tumor (Fig. 1). After 3 days of MR imaging examina- tion the patient had sudden onset paraplegia and was brought * Corresponding author at: Suite 121 and 141, Komplex EUREKA, 11800 Pulau Pinang, Malaysia. Tel.: +60 4653 2726; fax: +60 4653 2734. E-mail address: malam32789@yahoo.com (A.M. Alam). to emergency. Emergency surgery was performed for cervical lesion, which turned out to be meningioma in histopatholog- ical examination. The post-operative course was uneventful and the patient was discharged with no significant neurologic deficit. 2. Discussion This report presents a rare case of cervical dumbbell meningioma with bilateral acoustic schwannomas. Acoustic schwannoma account for approximately 7–8% of all primary intracranial tumors. Meningioma is the second most com- mon tumor of the spine, accounting for nearly 25% of such masses [1]. It is common in the female (80%) and the peak period of occurrence is in the fifth and sixth decades of life [1,2]. The most common site of occurrence is the thoracic spine, followed by the cervical spine and rarely occurs in the lumbosacral spine [1–3]. Approximately 90% of spinal meningiomas are intradural, with only about 5% extradural and the rest 5% are both intra and extradural [1]. MR imaging 1571-4675/$ – see front matter © 2005 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejrex.2005.07.001