What is the main finding?
Extensive leptomeningeal enhancement of the conus, with numerous enhancing nodules along the nerve roots of the cauda equina.
What german word is used to describe the appearance of the cord?
Zuckerguss (German for sugar icing) is used by some. "Sugar coating" is similar and easier to pronounce.
What are the most common sources of spinal leptomeningeal metastases?
Primary tumours include: CNS primaries (e.g. glioblastoma; ependymoma; medulloblastoma; pineal tumours (e.g. germinoma, pineoblastoma); choroid plexus neoplasms) and non-CNS metastatic malignancies (e.g. lung cancer; breast cancer; melanoma; haemopoietic neoplasms (e.g. lymphoma; leukaemia).
What features easily let you distinguish whether this patient's leptomeningeal disease is form a CNS primary or from a tumour located elsewhere in the body?
Extensive bony and hepatic metastases indicate a non-CNS source.
Abnormal pial enhancement of the conus, with numerous multilevel nodular enhancing foci along the nerve roots of the cauda equina. There is also diffuse dural enhancement, particularly posteriorly.
Extensive enhancing metastases seen throughout the lumbar vertebral bodies and sacrum. Vertebral body height is maintained, without fracture.
Hepatic metastases noted.