October 13, 2008

Leptomeningeal Carcinomatosis

Fig. Sagital T1 (post contrast) MR image shows nodular/irregular enhancement of the leptomeninges, especially in the posterior fossa (arrows). The patient was found to have esophageal carcinoma.


  • Most common tumors metastasize to meninges are breast, lung, melanoma
  • No identifiable primary malignancy in 2-4% of cases
  • Headache is the most common presenting symptom.
  • Diagnosis relies on cytological examination (CSF cytology or leptomeningeal biopsy). CSF markers and radiographic findings also can strongly support diagnosis.
  • Short median survival even with aggressive treatment
Radiographic Findings
  • Hydrocephalus
  • Meningeal enhancement
  • Thick, clumped nerve roots
  • Enhancing nodular deposits on surface of roots or CNS structures
  • Coexisting parenchymal, epidural or bony metastases

Balm M, et al. Leptomeningeal carcinomatosis: presenting features and prognostic factors. Arch Neurol 1996 (July 1996).

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