Presentation
Known patient with medulloblastoma underwent surgery and received chemo/radiotherapy and now for follow up.
Patient Data
Post-operative changes of the posterior fossa were noted.
There was diffuse nodular leptomeningeal enhancement of the brain sulci, CSF cisters, around the spinal cord as well as the roots of cauda equina representing diffuse leptomeningeal metastasis.
Moreover, there was diffuse intramedullary abnormal T2 signal intensity involving the whole spinal cord which was consistent with radiation changes.
MRI at initial presentation.
There is a 4th ventricular cavity midline ill defined mass, displaying low signal on T1, bright signal on T2, diffusion restriction on DWI and heterogeneous contrast enhancement. There was extension along the right foramen of Luschka as well.
Associated supratentorial hydrocephalic changes were noted with CSF permeation.
Case Discussion
Following surgical removal of the 4th ventricular mass, histopathology revealed medulloblastoma. The patient received whole brain and whole spine radiotherapy. After 2 years, on the follow up study, diffuse leptomeningeal spread was detected.