Leptomeningeal carcinomatosis or ischemic cerebrovascular di
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A lung cancer patient suspected to have leptomeningeal carcinomatosis was referred for radiation. A careful evaluation of the MRI by a neuroradiologist revealed multiple brain infarcts. Multidisciplinary meetings are important for patient's case.

The patient was referred to the Neuro-Oncology Unit for suspected leptomeningeal carcinomatosis. After careful evaluation of the MRI by a neuroradiology specialist at a multidisciplinary meeting, the diagnosis of multiple brain infarcts was made. Treatment with whole-brain-irradiation in this case would have been harmful to the patient and inappropriate.

A 82-years-old female, shortly after a locally advanced lung cancer diagnosis, prior to starting systemic therapy, developed right hemiparesis. Her past medical history includes a right bundle branch block and recent deep vein thrombosis. A Brain MRI with gadolinium showed scattered gyriform enhancement in supratentorial and infratentorial compartments. The lesions show increased T2 signal and some show diffusion restriction, no significant edema or mass effect are noted. The patient was referred to the Neuro-Oncology Unit for suspected leptomeningeal carcinomatosis to consider whole-brain irradiation.

A careful evaluation of the MRI by a neuroradiology specialist at a multidisciplinary meeting revealed that not all T2 hyperintense cortical lesions were enhancing, some lesions showed diffusion restriction and lesions location matched watershed distribution. Therefore, the diagnosis of multiple brain watershed infarcts was made. The patient was referred for further evaluation for ischemic cerebrovascular disease and a follow-up brain imaging showed improvement in the MRI abnormalities, with a resolution of enhancement, confirming the diagnosis of multiple brain infarcts.

This case emphasizes the importance of multidisciplinary discussions and involving imaging experts in these meetings. Treatment with whole-brain-irradiation in this case would have been harmful to the patient and inappropriate.

Source: https://onlinelibrary.wiley.com/doi/10.1002/ccr3.4339?af=R
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