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: 91
Gender: Female

CT Brain

Modality: 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

Modality: 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 a distant primary tumour. The images features are more favourable 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%.

On 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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Case Information

rID: 26530
Case created: 26th Dec 2013
Last edited: 10th Sep 2015
Inclusion in quiz mode: Included

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