Presentation
Breast cancer. Clinically patient deteriorated in the past week with severe paresthesias over the spine and limb weakness, severe dizziness, one episode of fall. Was diagnosed with leptomeningeal spread the previous year.
Patient Data
Thin rim of nodular enhancement (zuckerguss) of the leptomeninges throughout the spinal canal and the roots of the cauda equina from the craniocervical junction down to the conus medullaris. This was not evident on the prior scan.
No epidural metastasis. No osseous metastases. Normal cord.
No osseous metastases.
Normal appearances of the cord. No leptomeningeal enhancement.
The magnified view helps illustrate the sugar-coated appearances of the leptomeninges.
Case Discussion
The so-called "sugar coating" or zuckerguss (German for sugar icing) is seen in postcontrast images of the brain and spinal cord in patients with leptomeningeal drop metastases or leptomeningeal carcinomatosis.
It is relatively subtle and therefore can easily be missed if you don't look for it/ One can see this is a new finding compared to the MR done 4 months perviously.
Without contrast, it cannot be identified.
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