Presentation
Patchy lower limb weakness and sensory changes. Long-standing illness.
Patient Data
Abnormal pial enhancement of the conus, with numerous multilevel nodular enhancing foci along the nerve roots of the cauda equina. There is also diffuse dural enhancement, particularly posteriorly.
Extensive enhancing metastases seen throughout the lumbar vertebral bodies and sacrum. Vertebral body height is maintained, without fracture.
Hepatic metastases noted.
Multiple enhancing nodules are scattered along the cauda equina (blue arrows) with extensive leptomeningeal enhancement of the conus (yellow arrows). Numerous liver metastases ( * ) are most easily seen on T2 weighted images, as well as very extensive bony metastatic disease.
Case Discussion
This case illustrates typical appearances of very extensive leptomeningeal spinal metastatic disease, with extensive systemic disease.
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