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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Cases and figures

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    Figure 1: sugar coating
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    Case 1: from metastatic melanoma
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    Sugar coating
    Case 2: from colon adenocarcinoma
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    Case 3: from breast cancer
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     Nodules and thic...
    Case 4: from breast cancer
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