Mimicking Peroneal Neuropathy: A Case of Parasagittal Meningioma in Kurdistan, Iraq

November 4, 2025

A medical team in Kurdistan, Iraq, recently encountered a puzzling case where a patient’s symptoms initially suggested peroneal neuropathy, a condition affecting the nerves in the lower leg.However, further investigation revealed a far more complex diagnosis: a parasagittal meningioma, a type of brain tumor. The case underscores the importance of complete diagnostic evaluations when initial symptoms are atypical.

Initial misdiagnosis and Diagnostic Journey

The patient initially presented with symptoms commonly associated with peroneal neuropathy, including weakness in foot dorsiflexion – the ability to lift the foot upwards – and altered sensation. Physicians initially suspected a localized nerve issue, a relatively common ailment.However, the patient’s condition did not respond to typical treatments for peroneal nerve damage.

This lack of response prompted a more thorough investigation, leading to advanced imaging of the patient’s brain.This imaging revealed the presence of a parasagittal meningioma, a tumor that arises from the meninges-the membranes surrounding the brain and spinal cord. The tumor’s location was pressing on areas of the brain that control motor function, thus manifesting as symptoms resembling peroneal neuropathy. According to the National Brain Tumor society, meningiomas account for approximately 39% of all primary brain tumors.

understanding Parasagittal Meningiomas

Parasagittal meningiomas are typically benign, meaning they are non-cancerous, but their location can cause notable neurological problems. These tumors often develop slowly, and symptoms can vary widely depending on their size and proximity to critical brain structures. Common symptoms include headaches, seizures, and gradually worsening neurological deficits. The particular case in Iraq highlights the unusual presentation where symptoms mirrored those of a peripheral nerve disorder.

“Did You Know?” Meningiomas are more common in women than in men, with a roughly 2:1 ratio.

The Importance of Differential Diagnosis

This case serves as a critical reminder for medical professionals to consider a broad differential diagnosis, especially when patients present with atypical symptoms or fail to respond to standard treatments. A delay in accurate diagnosis can perhaps lead to inappropriate treatment and a worsening of the patient’s condition. advanced neuroimaging techniques, such as MRI and CT scans, are crucial for identifying these types of tumors.

Condition	Typical Symptoms	Key Diagnostic Tools
Peroneal Neuropathy	Foot drop, numbness/tingling in lower leg/foot, weakness in foot and ankle.	Neurological examination,Nerve conduction studies,Electromyography (EMG).
Parasagittal Meningioma	Headaches, seizures, weakness (potentially mimicking neuropathy), cognitive changes.	MRI, CT scan, Biopsy (for confirmation).

“Pro Tip” If you experience persistent neurological symptoms, especially those that don’t improve with initial treatment, seek a second opinion and request advanced imaging.

The medical team in Iraq successfully managed the patient’s condition through surgical intervention. The patient’s prognosis remains positive,though long-term follow-up will be necessary to monitor for any recurrence.

Advances in Meningioma treatment

Treatment for meningiomas has evolved substantially over the past decade, with advancements in surgical techniques, radiation therapy, and targeted drug therapies. Minimally invasive surgical approaches are now more common,reducing recovery times and minimizing risks. Radiation therapy, including stereotactic radiosurgery, offers a non-invasive option for treating smaller tumors or those in challenging-to-reach locations. Ongoing research is also exploring novel drug therapies that can inhibit meningioma growth.

Frequently Asked Questions About Meningiomas

• What is a meningioma? Meningiomas are tumors that grow from the meninges, the membranes surrounding the brain and spinal cord.
• Are meningiomas cancerous? Most meningiomas are benign (non-cancerous), but they can still cause problems due to their location and pressure on surrounding structures.
• What are the common symptoms of a meningioma? Symptoms vary depending on the tumor’s location,but can include headaches,seizures,weakness,and vision changes.
• How is a meningioma diagnosed? Diagnosis typically involves neuroimaging techniques like MRI and CT scans.
• What are the treatment options for meningiomas? Treatment options include surgery,radiation therapy,and sometimes observation for slow-growing tumors.
• Can a brain tumor mimic other neurological conditions? Yes, in rare cases, brain tumors can present with symptoms that resemble other neurological disorders like peroneal neuropathy.
• What is the prognosis for someone diagnosed with a meningioma? The prognosis varies based on tumor size,location,and grade,but many patients experience good outcomes with appropriate treatment.

What are your thoughts on the complexity of neurological diagnoses? Have you or someone you know experienced a diagnostic challenge like this?

Share this article and let us know your thoughts in the comments below!

How might regional epidemiological factors influence a clinician’s diagnostic approach to foot drop in a patient from Kurdistan, Iraq?

Understanding the Diagnostic Challenge

Peroneal neuropathy, often presenting as foot drop and lateral leg weakness, is a relatively common neurological condition. However, atypical presentations can lead to misdiagnosis, delaying appropriate treatment. This article details a compelling case study from kurdistan, Iraq, where a parasagittal meningioma initially mimicked peroneal nerve pathology, highlighting the importance of comprehensive neurological evaluation. The differential diagnosis of foot drop and leg weakness must always be broad.

The Case Presentation: A 58-Year-Old Male

A 58-year-old male from Erbil, Kurdistan, presented with a six-month history of progressive weakness in his right foot, accompanied by a noticeable foot drop during gait. Initial clinical assessment strongly suggested common peroneal nerve palsy.Electrodiagnostic studies (EMG/NCS) were performed,revealing evidence consistent with axonal degeneration affecting the peroneal nerve. Conservative management, including physiotherapy and bracing, was initiated, but the patient experienced minimal improvement. This lack of response to standard peroneal nerve injury treatment raised concerns.

Red Flags & Further Investigation

Several factors prompted a re-evaluation of the diagnosis:

* Atypical Progression: The slow, insidious onset and lack of significant improvement with conservative treatment were unusual for typical peroneal neuropathy.

* Absence of Trauma: The patient denied any history of trauma, compression, or other known causes of peroneal nerve damage.

* Neurological Examination findings: Subtle but persistent sensory deficits extending beyond the typical peroneal nerve distribution were noted during repeated examinations.

* Imaging Concerns: Despite initial normal radiographs,persistent clinical suspicion led to the ordering of an MRI of the lumbar spine and brain.

The Unexpected Finding: Parasagittal Meningioma

The brain MRI revealed a large, extra-axial mass located in the parasagittal region, consistent with a meningioma. Crucially, the tumor was compressing the underlying brain tissue and disrupting corticospinal tracts responsible for lower limb motor function. This compression was the root cause of the patient’s symptoms, effectively mimicking peroneal neuropathy.

What is a Parasagittal Meningioma?

Meningiomas are tumors that arise from the meninges – the membranes surrounding the brain and spinal cord. Parasagittal meningiomas are located along the midline of the brain, often near the superior sagittal sinus. While typically benign, their location can cause significant neurological deficits due to compression. Brain tumor symptoms can be varied and often depend on the location and size of the tumor.

Diagnostic Confirmation & Surgical Intervention

Following the MRI findings, a surgical consultation was obtained. A craniotomy was performed, and the meningioma was completely resected. histopathological examination confirmed the diagnosis of a World Health Institution (WHO) Grade I meningioma.

Post-Operative Recovery & outcome

Post-operatively, the patient experienced a gradual but significant improvement in his right foot strength and gait.The foot drop resolved over several months with continued physiotherapy. Follow-up neurological examinations demonstrated a return to near-normal function. This case underscores the importance of considering intracranial pathology in patients presenting with atypical neurological symptoms.

The Importance of Differential Diagnosis in Neurological Cases

This case highlights a critical lesson in neurology: always maintain a broad differential diagnosis. While peroneal neuropathy is a common cause of foot drop, other conditions, including:

* Spinal Stenosis: Narrowing of the spinal canal can compress nerve roots.

* Peripheral Neuropathy (beyond peroneal): Diabetes, vitamin deficiencies, and other systemic conditions.

* Stroke: Rarely, a stroke can present with isolated foot drop.

* Space-Occupying Lesions: Tumors, abscesses, or hematomas.

* Charcot-Marie-Tooth Disease: A hereditary neuropathy.

must be considered, especially when the clinical picture is atypical or unresponsive to standard treatment. Neurological assessment should be thorough and include a detailed history, comprehensive neurological examination, and appropriate investigations.

Challenges in Resource-Limited Settings (Kurdistan, Iraq)

The diagnostic delay in this case was partially attributable to limited access to advanced imaging modalities in the initial stages of care. While MRI is the gold standard for evaluating brain tumors, its availability can be restricted in resource-limited settings like parts of Kurdistan, Iraq. This emphasizes the need for increased investment in healthcare infrastructure and training of medical personnel in these regions. Healthcare access remains a significant challenge globally.

Key Takeaways for Clinicians

* Don’t Anchor: Avoid premature diagnostic closure. Be willing to revisit the diagnosis if the patient’s response to treatment is not as expected.

* Expand the differential: Consider less common causes of peroneal-like symptoms, including central nervous system lesions.

* Embrace Imaging: Utilize appropriate imaging modalities (MRI) when clinical suspicion warrants, even if initial investigations are inconclusive.

* Consider Regional Epidemiology: Be aware of the prevalence of certain conditions in your geographic area.