Abstract
This case report describes a 62-year-old female with a history of gastroesophageal reflux disease and irritable bowel syndrome who presented with progressively worsening left-sided weakness and gait instability of two weeks' duration. A CT of the head without contrast revealed a 3.7 × 3.6 cm right frontal lobe mass with vasogenic edema and significant midline shift. A subsequent brain MRI with and without contrast demonstrated a 5.8 × 4.6 × 4.2 cm intra-axial, aggressive-appearing mass centered posteriorly within the right frontotemporal lobe, with extensive surrounding edema and local mass effect. The patient underwent surgical resection via craniotomy, with subsequent resolution of focal deficits. Histopathology confirmed an anaplastic meningioma, WHO Grade III, despite the fact that meningiomas are typically extra-axial tumors. This case underscores that high-grade meningiomas, although rare, can present in unexpected ways and at unpredictable sites, creating diagnostic challenges. It also emphasizes the importance of timely neurosurgical intervention to improve the chances of recovery.