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Leptomeningeal metastases — SCE Neurology MCQ

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HardNeuro-oncologyLeptomeningeal metastasesSCE Neurology

A patient with metastatic breast cancer develops headache, multiple cranial neuropathies and painful cauda-equina symptoms. MRI shows multifocal leptomeningeal enhancement. Which test most directly confirms the suspected diagnosis?

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Correct answer: C — Cerebrospinal-fluid cytology from a large sample repeated after an initially negative result

The best answer is “Cerebrospinal-fluid cytology from a large sample repeated after an initially negative result”. The clinical and MRI pattern suggests leptomeningeal metastasis; CSF cytology is the direct confirmatory test and sensitivity rises with repeat sampling. “Serum acetylcholine-receptor antibodies” is plausible in a different neurological context, but the decisive findings here argue against it. “Temporal-artery biopsy” is plausible in a different neurological context, but the decisive findings here argue against it. “Carotid duplex ultrasonography” is plausible in a different neurological context, but the decisive findings here argue against it. “Dopamine-transporter imaging” is plausible in a different neurological context, but the decisive findings here argue against it.

Reference: EANO–ESMO guideline for leptomeningeal metastasis: https://pmc.ncbi.nlm.nih.gov/articles/PMC10619142/