Sugar coating

The so called "sugar coating" or zuckerguss (German for sugar icing) is seen in post contrast images of the brain and spinal cord in patients with leptomeningeal drop metastases or leptomeningeal carcinomatosis. It is seen both as a result of CNS involvement from distant primaries as well as direct spread from CNS malignancies.

Primaries include:

Differential diagnosis

Considerations include:

  • leptomeningeal inflammation/infection
  • post-surgical/post-lumbar puncture changes
  • prominent pial vessels
    • normally only present in the very midline
    • may be enlarged with spinal AVMs or AVFs
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Article Information

rID: 2126
Section: Signs
Synonyms or Alternate Spellings:
  • Sugar coated spine
  • Zuckerguss

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    Figure 1: sugar coating
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    Case 1: from metastatic melanoma
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