Intra and extra-axial brain metastasis

Case contributed by Dr Bruno Di Muzio

Presentation

Patient with inoperable adenocarcinoma of the colon. Previous treatment for normal pressure hydrocephalus.

Patient Data

Age: 90 years
Gender: Female

CT Brain

ct

CT study shows diffusely hyperattenuating thickened nodular extra-axial, bilateral space-occupying lesions originating from the meninges (mainly dura mater) over bilateral cerebral convexities. There is also a left frontal lobe nodule with similar characteristics. 

MRI Brain

mri

MRI study shows diffuse nodular space-occupying lesions originating from the meninges (mainly dura mater) over bilateral cerebral convexities, with high signal intensity on T1-weighted and FLAIR. Again demonstrated a similar lesion in the left frontal lobe parenchyma. 

Patient in acute renal failure - no contrast phase. 

Case Discussion

This case illustrates a secondary meningeal involvement due to a distant primary tumor. The images features are more favorable to a dural involvement than a leptomeningeal involvement

CNS metastases from colorectal cancer are an uncommon occurrence, with an estimated incidence of 1% to 3%.

In this case, the high signal intensity on T1 and the hyperattenuation on CT suggest hemorrhage or melanin. There was no known history of melanoma.

The patient died on the day after the MRI exam, there is no histological confirmation.

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