A 55 year-old with lung cancer and leg numbness

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A 55 year-old with lung cancer and leg numbness Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology

Vignette 55 year old woman with lung cancer Presented with leg numbness Systemic disease well controlled MRI was precluded by metallic cardiac device © 2013 American Academy of Neurology Glover et al.

CT Myelogram Glover et al. Panel 1 (top): These axial images from a CT after myelogram demonstrate left sided location of disease at C6 and L1. Though infrequently used in the era of MRI, this modality can have an important role in the evaluation of suspected leptomeningeal carcinomatosis. Panel 2 (bottom): The sagittal images reveal focal masses in the intradural, extramedullary space behind L1 and C6 consistent with metastases from the patient’s known lung cancer. Glover et al. © 2013 American Academy of Neurology

Leptomeningeal Lung Carcinoma CT Spine was unremarkable CSF (x2) demonstrated mild protein elevation but no abnormal cells CT myelogram revealed bulky disease The third CSF sample obtained at the time of myelogram confirmed the diagnosis of leptomeningeal metastasis To detect leptomeningeal carcinomatosis with 90-98% sensitivity, three taps are needed. False negatives can be minimized by withdrawal of 10.5 mL of CSF and immediate processing.1,2. References 1. Freilich RJ, Krol G, DeAngelis LM. Neuroimaging and cerebrospinal fluid cytology in the diagnosis of leptomeningeal metastasis. Annals of Neurology 1995; 1:51-57. 2. Glantz MJ, Cole BF, Glantz LK, et al. Cerebrospinal fluid cytology in patients with cancer: minimizing false negative results. Cancer 1998; 2:733-739. © 2013 American Academy of Neurology Glover et al.