Posture-Dependent Focal Neurologic Deficits in Meningioma-Related Superior Sagittal Sinus Obstruction: An Illustrative Case

Venous hypertension contributes to a broad range of clinical manifestations across organ systems. In many venous disorders, symptoms fluctuate with posture because gravitational and mechanical factors alter venous return and regional venous pressures. We present a unique case of posture-dependent focal neurologic deficits in a patient with a large malignant meningioma involving the superior sagittal sinus. The patient experienced recurrent transient right-sided weakness and paresthesia when reclined, with improvement after assuming an upright position. Neuroimaging demonstrated a large posterior vertex meningioma with the encasement of the superior sagittal sinus and no evidence of significant arterial occlusion. Published literature on meningioma-related venous sinus compromise primarily describes headache, papilledema, and elevated intracranial pressure rather than posture-dependent focal neurologic deficits. Although there is a physiologic rationale to suspect that positional change could influence symptoms in venous outflow disorders, this question remains largely unstudied in patients with meningioma-induced venous hypertension. Current evidence does not support positional change as an established disease-specific treatment in cerebrovascular venous disorders. We therefore present this case as a hypothesis-generating example of posture-sensitive venous pathophysiology in the intracranial compartment. The greater recognition of this phenomenon may improve diagnostic reasoning and inform future study of dynamic venous disorders.