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.
Facts
- 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
- Hydrocephalus
- Meningeal enhancement
- Thick, clumped nerve roots
- Enhancing nodular deposits on surface of roots or CNS structures
- Coexisting parenchymal, epidural or bony metastases
References:
Balm M, et al. Leptomeningeal carcinomatosis: presenting features and prognostic factors. Arch Neurol 1996 (July 1996).
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