Leptomeningeal carcinomatosis

Question 1

causes of leptomeningeal carcinomatosis (LC)

Answer 1

from breast cancer, lung cancer, malignant melanoma

Question 2

presentation of leptomeningeal carcinomatosis

Answer 2

see subacute onset of headache and various neurological symptoms and signs: AMS, seizure and multifocal neurological deficits

Question 3

How to test for suspected leptomeningeal carcinomatosis?

Answer 3

Get MRI of brain with gadolinium (brain and spinal cord) which has 76-87% sensitivity

Question 4

what test is ordered after MRI is performed for suspected leptomeningeal carcinomatosis ?

Answer 4

Get an LP with cytology to increase diagnostic yield of MRI (can be neg in 20% of cases) Avoid in pts with large intracranial or spinal masses due to risk for cerebral herniation.

Question 5

leptomeningeal carcinomatosis CSF findings are

Answer 5

elevated opening pressure, low glucose, elevated protein and mild lymphocytic pleocytosis.

Question 6

what is seen on MRI with leptomeningeal carcinomatosis?

Answer 6

linear or nodular leptomeningeal enhancement along the surface of the brain or spinal cord.