Patient with breast cancer and on chemotherapy developed disturbed conscious level.
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There is hyperintense FLAIR signal seen within the sulci of the occipital lobes and folia of the cerebellum. No related abnormalities could be detected at T1, T2, T2* or DWI images, which indicates this signal is not blood. Following contrast administration, there is leptomeningeal enhancement best seen within the cerebellar folia, anterior temporal regions bilaterally, lining the cerebellar tonsils, and at the interpeduncular fossa.
Hyperintense CSF in FLAIR images raises the possibility of subarachnoid hemorrhage. The differential diagnosis includes leptomeningeal carcinomatosis, leptomeningitis, and oxygen therapy. Leptomeningeal enhancement following contrast administration is suspicious for metastatic spread, especially in a patient with known cancer.