Leptomeningeal Disease

FACTS


• may be presenting finding in up to 50% of patients with cancer

HPI

  • Hearing loss
  • HA
  • mental status changes
  • lethargy
  • seizure
  • ataxia

PHYSICAL EXAM

detailed cranial nerve exams (the cancer likes to go straight to the nerves)

IMAGING

MRI brain with and without contrast
  • look at IACs and CN 7/8, all cranial nerves
A/P
  • Rule out mass lesion with MRI or CT
  • LP with cytology to evaluate for malignant cells (at least 10 cc), fungal/bacterial Cx, tumor marks, protein/glucose
  • -> NOTE: initially this may be normal
  • Intra-thecal chemotherapy
  • palliative shunt (counsel this is a terminal point)
 

Imaging Findings of LMD

Lack of T2 FLAIR Suppression
Lack of T2 FLAIR suppression in posterior parieta sulci
Lack of T2 FLAIR suppression in posterior parieta sulci
Review: Failure of T2 suppression
recall: T2 FLAIR normally suppresses signal from CSF, i.e. makes CSF black
  • when this fails: that means something other CSF was there
    • this can be blood, pus, meningitis, cancer, seizures (rare)