Hemorrhagic Papilledema in a Patient With End‐Stage Renal Disease and Meningioma: A Case Report

Anterior cranial fossa meningioma can present with a constellation of symptoms that pose a diagnostic challenge, especially in patients with significant comorbidities like end-stage renal disease (ESRD). We report a case where the classic triad of visual loss, headache, and anosmia was initially complicated by the patient's renal background and systemic inflammation. A 53-year-old woman with ESRD and hypertension presented with a one-month history of progressive, non-correctable bilateral visual loss and a two-week history of headache. She also reported complete anosmia. Her medication regimen was comprehensive for her comorbidities. Uncorrected and corrected visual acuity was 6/10 OD and 7/10 OS. Funduscopy revealed bilateral optic disc edema with peripapillary hemorrhages. The Marcus Gunn test was negative. Systemic inflammation was evidenced by an elevated ESR (51 mm/h) and a positive CRP. Brain MRI confirmed the presence of a meningioma. Her blood pressure was controlled at 130/83 mmHg. The patient's presentation is a classic depiction of an anterior cranial fossa meningioma, likely originating from the olfactory groove or planum sphenoidale. The tumor explains the anosmia via direct nerve compression and the papilledema via obstruction of CSF pathways and elevated intracranial pressure. The controlled blood pressure and the specific nature of the triad helped exclude hypertensive emergency and uremic encephalopathy as primary causes. The elevated inflammatory markers, while raising initial suspicion for vasculitis or other inflammatory conditions, are also a known, though less common, associated finding with meningioma. This case underscores the critical importance of pursuing a central nervous system (CNS) etiology for neurological symptoms, even in medically complex patients. The triad of papilledema, headache, and anosmia is highly suggestive of an anterior cranial fossa mass lesion and warrants prompt neuroimaging. Systemic inflammation should not prematurely divert the diagnostic workup from considering primary CNS tumors.