What symptoms can be expected with an interhemispheric falx meningioma measuring 1.4x1.1x1.2 cm?

Expected Symptoms of Interhemispheric Falx Meningioma (1.4 x 1.1 x 1.2 cm)

A meningioma of this size (approximately 1.4 cm) located at the interhemispheric falx may be asymptomatic in approximately one-third of cases, but when symptomatic, headache is the most common presenting feature, followed by seizures and lower extremity weakness with crural dominance. 1

Most Common Symptom Patterns

Headache (Most Frequent Symptomatic Presentation)

• Headache occurs in approximately 27-30% of symptomatic falcine meningioma patients and represents the most common complaint when symptoms are present 1, 2
• The headache pattern typically involves progressive worsening over time rather than sudden onset 2
• For meningiomas at the skull base or specific locations, headaches are often a prominent feature, though your tumor's interhemispheric location may produce more variable headache patterns 2

Motor Deficits ("Falx Syndrome")

• Lower extremity weakness with crural (leg) dominance is characteristic of falcine meningiomas, occurring in approximately 9-10% of cases 1
• This "falx syndrome" presents as contralateral motor palsy affecting the leg more than the arm, with facial involvement typically absent 3
• The motor deficit results from compression of the medial motor cortex (paracentral lobule), which controls lower extremity function 3

Seizures

• Seizures occur in approximately 14-15% of falcine meningioma patients 1
• Seizures can be either focal or generalized and may indicate the location of the lesion 1

Cognitive and Psychiatric Symptoms

• Cognitive impairment and personality changes can occur, particularly with anterior falx meningiomas 4
• Psychotic symptoms have been reported in cases of anterior interhemispheric falx meningiomas, especially in patients over age 45 presenting with new-onset psychiatric symptoms 4
• Headache accompanied by cognitive difficulty has been documented in falcotentorial region meningiomas 5

Asymptomatic Presentation

• Approximately one-third (33%) of falcine meningioma patients are completely asymptomatic at diagnosis 1
• Given your tumor's relatively small size (1.4 cm), asymptomatic presentation is entirely possible and may represent an incidental finding on imaging

Size-Related Considerations

Your tumor size of 1.4 cm is relatively small, which significantly influences symptom likelihood:

• Smaller meningiomas are more likely to be asymptomatic or produce subtle symptoms 1
• Symptoms typically correlate with tumor size, location, and rate of growth rather than size alone
• The middle third of the falx (most common location, 55-78% of cases) tends to produce the classic falx syndrome when symptomatic 1

Critical Warning Signs Requiring Immediate Evaluation

Watch for these red flags that warrant urgent medical attention:

• Progressive worsening of headaches over weeks to months 2
• New-onset seizures, particularly in adults over 45 years 4
• Development of leg weakness or gait disturbance 1, 3
• Visual disturbances including blurred vision or diplopia 2
• Nausea and vomiting suggesting raised intracranial pressure 2
• Personality changes or cognitive decline 2, 4

Common Pitfalls to Avoid

• Do not dismiss progressive headaches as benign, especially if they worsen over time or change in character 2
• New psychiatric symptoms in patients over 45 should raise suspicion for organic brain disease, including meningioma 4
• Subtle lower extremity weakness may be attributed to other causes; maintain high suspicion for falx syndrome with interhemispheric lesions 3