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Atypical meningioma: case report A 53-year-old woman developed atypical meningioma during treatment with chlormadinone and cyproterone for endometriosis [routes and durations of treatment to reaction onset not stated]. The woman presented with 3 weeks history of transient language and right motor disorder induced by multiple focal onset seizures. Her medical history included cesarean section 29 years ago, eclampsia 22 years ago and surgery for endometriosis 14 years ago. For endometriosis, she had been receiving hormonal treatment including cyproterone [cyproterone acetate] 25 mg/day for 2 months, and then 50 mg/day for 101 months. She also received chlormadinone [chlormadinone-acetate] 5 mg/day for 68 months, and then 10 mg/day for 83 months. Between 2004–2009, she received 3 injections of SC triptorelin. Following her presentation, physical examination showed right hemiparesis involving the face and upper limb along with language disorder with dysarthria. Eye examination showed normal visual acuity with mild bilateral optic disc pallor of the temporal sides. Subsequent brain MRI showed multiple intradural and extra-cerebral masses indicative of left central meningioma associated with anterior skull base meningiomatosis. The largest lesion was in front of the left central region, which was associated with an osteoma, inducing a focal mass effect and mild midline deviation. Additionally, she had lesions, one on the basal and anterior parts of the falx cerebri, one on the anterior and basal parts of the right frontal bone, one on the left olfactory groove and one on the right anterior clinoid process were smaller. In the view of disability induced by permanent focal neurological deficit, chronic intracranial hypertension determined by the bilateral optic disc pallor on ophthalmologic examination and the volume and mass effect of the symptomatic left central meningioma, she had removal of the left central lesion. In addition to this, chlormadinone and cyproterone were completely discontinued. After 3 weeks of therapy discontinuation, she underwent standard leftfronto-parietal craniotomy under general anesthesia. After the surgery, she exhibited right hemiparesis and dysarthria were observed. From post-operative day 1, she started receiving dedicated rehabilitation. On postoperative day 10, she was discharged home. Based on neuropathologic examination, a diagnosis grade II atypical meningioma was established. At a follow-up after 25 months of surgery, she had controlled seizures without antiepileptic drugs, slight dysarthria and fatigue. Follow-up examination confirmed complete surgical resection, with no recurrence of the left central meningioma and significant regression of all other lesion, except for the right frontal lesion. Roux A, et al. Symptomatic progestin-associated atypical grade II meningioma. A first case report. Neuro Chirurgie 66: 174-178, No. 3, Jun 2020. Available from: URL: http:/ 803499485 /doi.org/10.1016/j.neuchi.2019.12.013

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