Presentation
Breast cancer. Confusion.
Patient Data
Tiny faint foci of enhancement bilaterally at the grey white matter interface in both cerebral hemispheres.
Diffuse faint enhancement of the heads of caudate and lentiform nuclei.
Innumerable small enhancing lesions throughout both cerebral hemispheres at the grey-white matter interface, both cerebellar hemispheres and mesencephalon.
The greatest density of lesions is in the heads of caudate and both lentiform nuclei.
Diffuse thickening and enhancement of the dura.
Case Discussion
Zuckerguss is the sugar coated appearance from multiple tiny leptomeningeal metastases.
It is often very difficult, if not impossible to appreciate on CT and routine MR sequences, but is very florid following contrast administration.
It is most commonly associated with breast cancer.