Leptomeningeal carcinomatosis

Case contributed by Bruno Di Muzio


Previous history of breast carcinoma with a solitary brain metastasis resection one year ago followed by whole brain radiotherapy. Now presenting with headaches.

Patient Data

Age: 45 years
Gender: Female

MRI brain


Prior left-sided parietal craniotomy is noted, with no subjacent changes to suggest tumor recurrence. A small amount of dural thickening is in keeping with expected post-operative change. The degree of T2 signal hyperintensity within the right occipital lobe as also are almost entirely resolved, with no abnormal enhancement in this region.

On a number of images, particularly on axial postcontrast T1 weighted sequences, there is increased leptomeningeal enhancement, particularly around the medulla and enhancement of cranial nerves (particularly the 6th cranial nerves bilaterally).

The brain is unremarkable, with no intra extra-axial collection or mass evident.


Prominent leptomeningeal enhancement in this clinical setting is concerning for leptomeningeal carcinomatosis.

Annotated image

Leptomeningeal enhancement (yellow arrows) noted surrounding the medial orbital gyrus and straight gyrus bilaterally, as well as observed in the anterior pons and surrounding the abducens nerve bilaterally

Case Discussion

The image features of leptomeningeal enhancement in the context of a known metastatic breast cancer favor the diagnosis of a leptomeningeal carcinomatosis. This case has no histopathological confirmation.

Usually the abducens nerves are not well demonstrate on T1 images, in this case, however, the enhancement around the nerves made it easily identified.  


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