Leptomeningeal Carcinomatosis — SCE Neurology MCQ

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ModerateNeuro-oncologyLeptomeningeal CarcinomatosisSCE Neurology

A 65-year-old man with metastatic RCC develops headache, confusion, and bilateral 6th nerve palsies. MRI shows diffuse leptomeningeal enhancement. CSF cytology shows malignant cells. What is the diagnosis?

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Correct answer: B — Leptomeningeal carcinomatosis

Leptomeningeal carcinomatosis causes multifocal cranial neuropathies, headache, cognitive changes, and hydrocephalus. MRI shows leptomeningeal enhancement. CSF shows malignant cells, elevated protein, low glucose. A: Bacterial meningitis has fever and neutrophilic CSF. C: Viral meningitis has normal glucose. D: Granulomatous meningitis lacks malignant cells. E: Vasculitis lacks malignant cells.

Reference: NICE NG99; EAN Leptomeningeal Guidelines