MRI Evaluation of Unusual Presentations of Intracranial Meningioma: A Case Series

Intracranial meningiomas, though typically slow-growing and benign, can present significant diagnostic challenges when located in atypical anatomical sites or associated with unusual clinical manifestations. This case series highlights five patients with meningiomas arising in uncommon regions, including the olfactory groove, intraventricular space, sinonasal cavity, and anterior and posterior cranial fossae. Clinical presentations ranged from anosmia and visual disturbances to cranial nerve deficits and features of raised intracranial pressure. Advanced imaging, particularly MR spectroscopy, was instrumental in diagnosis, demonstrating characteristic choline and alanine peaks that differentiated meningiomas from other neoplasms. Some lesions displayed heterogeneous enhancement, irregular margins, and bone erosion, mimicking aggressive or non-meningothelial tumours. Recognition of these atypical radiological and clinical variants is crucial for accurate diagnosis, optimal surgical planning, and improved patient outcomes.