Female, 54 years old, with history of metastatic triple negative breast cancer with headache and abnormal CT findings. Pathologic leptomeningeal enhancement is demonstrated most notably in the right frontal lobe, but also along the brainstem and fissures of the cerebellum. Abnormal enhancement is seen along the cisternal segments of the fifth cranial nerves, within the IACs, and along the lower cranial nerve roots arising from the medulla.No evidence of significant parenchymal edema or generalized mass effect is seen. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is detected. The ventricles remain normal in size and shape. There is evidence of widespread osseous metastatic disease.
Diffuse pathologic leptomeningeal enhancement is seen which, given the clinical context, most likely represents leptomeningeal spread of disease.