Known metastatic oesophageal malignancy. Now extreme nausea, dizziness and confusion
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T1 pre-contrast is normal but the FLAIR sequence shows CSF hyperintensity within sulci especially posteriorly and over the vertex. Following contrast injection there is diffuse enhancement within the leptomeninges (termed an "icing sugar" appearance especially in the folia of the superior cerebellum) most marked over the vertex, posteriorly and cerebellum.
CSF at lumbar puncture contained abnormal malignant cytology.
Leptomeningeal metastases, also know as carcinomatous meningitis, refers to the spread of malignant cells through the CSF space.