This 41 year-old male patient presented with headache, confusion, dyskinesia, and reduced level of conciousness. He had a prior history of ganglioneurocytoma of the cervical spine diagnosed 2 years earlier treated with multiple resections and radiotherapy. The sagittal post-gadolinium fat-sat T1-weighted image above shows a large cystic/solid enhancing cervical tumour mass. There is evidence of extensive leptomeningeal tumour spread, including around the cerebellum. There is low signal in the upper cervical vertebral bodies – a typical post-radiotherapy appearance. The behaviour of this lesion is more aggressive than expected with ganglioneurocytoma, raising the possibility of malignant degeneration.
Primary CNS tumours which may give rise to CSF disseminated metastases include anaplastic astrocytoma, GBM, ependymoma, medulloblastoma, germinoma and choroid plexus carcinoma. Non-CNS tumours may also give this pattern, including lung and breast carcinoma, melanoma, lymphoma and leukaemia.
Reference: Ross JS, et al. Diagnostic Imaging: Spine Amirsys 2004
Credit: Dr Laughlin Dawes