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Brain metastases — SCE Neurology MCQ

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EasyNeuro-oncologyBrain metastasesSCE Neurology

A 71-year-old woman presented with new seizures and multiple enhancing lesions with vasogenic oedema in known lung cancer. On examination, there was mild hemiparesis and headache. Initial investigations showed: MRI showed grey-white junction ring-enhancing lesions. What is the most appropriate investigation?

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Correct answer: B — MRI brain with gadolinium

MRI brain with gadolinium is the best answer because the vignette describes Brain metastases: multiple junctional enhancing lesions in systemic cancer suggest metastases. MRI brain with diffusion-weighted imaging is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. CSF JC virus PCR and MRI whole spine with contrast are less appropriate because they would require different localisation, timing or test findings; Nerve conduction studies and EMG would fit a different syndrome. Clinical pearl: multifocal glioma is less likely with known disseminated cancer.

Reference: NICE NG99; EANO guidance; ABN paraneoplastic guidance