Abstract
Cerebral lymphangioma is an extremely rare entity, especially in adults. We report the case of a 38-year-old male who presented with diabetic ketoacidosis (fasting glucose: 4.65 g/L; glycated hemoglobin (HbA1c): 9.5%; urinary ketones and glucose: 4+ (highly positive)), severe holocranial headache, left hemiparesis, and agitation. MRI revealed a 58×46.5 mm right parietal extra-axial lesion with cystic and hemorrhagic components, initially suggestive of a cystic meningioma. Gross total surgical resection was performed following metabolic stabilization. Histopathology confirmed the diagnosis of lymphangioma. Postoperatively, the patient experienced a marked reduction in headache intensity (from 8/10 to 2/10 on the visual analog scale) and improvement in motor strength. This case illustrates the diagnostic challenge posed by cerebral lymphangiomas, which may closely mimic other cystic extra-axial lesions on imaging, particularly hemorrhagic meningiomas. It also demonstrates that complete surgical resection can result in favorable clinical outcomes. To our knowledge, this is one of the very few documented cases of cerebral lymphangioma in an adult, underscoring the need for increased awareness and further case reports to guide diagnosis and management.