CT brain is not sensitive or specific, may show intracranial mass
MRI brain and spine with contrast preferred (70% sensitivity, 77-100% specificity)
Leptomeningeal enhancement
Hydrocephalus
Subependymal nodules or deposits
Lumbar Puncture-mainly to rule out infectious etiology in ED
Elevated opening pressure
Glucose, protein, cell count and cytology can be abnormal
Malignant cells on CSF smear
Leptomeningeal enhancement
Hydrocephalus
Subependymal nodules or deposits
Elevated opening pressure
Glucose, protein, cell count and cytology can be abnormal
Malignant cells on CSF smear
Leptomeningeal enhancement or lesions on MRI
Malignant cells on CSF smear
Neoplastic meningitis
Migraine headache
Drug induced aseptic meningitis
Tension headache
Primary Amebic Meningoencephalitis
Cluster headache
Primary CNS lymphoma
Meningitis/encephalitis