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(a) Sagittal and (b) transversal T1-weighted contrast-enhanced magnetic resonance imaging (MRI) of the spine demonstrates meningeal enhancement along the lumbar spinal canal (arrows). Additional enhancement was seen in the cauda equine nerve roots. The biopsy was performed on level L 2/3 (long arrow in (a), level of (b)).
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fig2: (a) Sagittal and (b) transversal T1-weighted contrast-enhanced magnetic resonance imaging (MRI) of the spine demonstrates meningeal enhancement along the lumbar spinal canal (arrows). Additional enhancement was seen in the cauda equine nerve roots. The biopsy was performed on level L 2/3 (long arrow in (a), level of (b)).

Mentions: Cranial computed tomography (CCT) on admission now revealed marked ventricular enlargement. Magnetic resonance imaging (MRI) exhibited enlargement of the lateral ventricles and the third ventricle with periventricular high intensity signal on T2WI suggesting transependymal absorption or tumor spreading (Figures 1(e) and 1(f)). There were no signs of local tumor recurrence. Meningeal contrast enhancement was detected around the medulla (arrow head in Figure 1(f)). MRI of the whole spine showed enhancement along the leptomeninges and partially nodular enhancement of the dura. The cauda equina fibers appeared thickened and clotted together (arrow head in Figures 2(a) and 2(b)). Lumbar puncture repeatedly revealed yellow and muddy CSF with an increased opening pressure of about 50 cm H2O. CSF examination showed marked elevation of protein (15972 mg/l), slightly elevated cell count (16/μL), and normal glucose and lactate. Cytological CSF examination showed monocytes and lymphocytes but was free of tumor cells.

Acute Hydrocephalus due to Secondary Leptomeningeal Dissemination of an Anaplastic Oligodendroglioma

Stark AM, Hugo HH, Mehdorn HM, Knerlich-Lukoschus F - Case Rep Med (2009)

Bottom Line: Repeated lumbar puncture revealed increased cerebro-spinal fluid (CSF) pressure and protein content.Malignant cells were not detectable.Surgical treatment consisted in (1) placement of an ommaya reservoir for daily CSF puncture, (2) Spinal dural biopsy confirming leptomeningeal oligodendroglioma metastasis, and (3) ventriculo-peritoneal shunt placement after CSF protein has decreased to 1500-2000 mg/l.

Affiliation: Department of Neurosurgery, Schleswig-Holstein University Medical Center, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany.

ABSTRACT
Secondary leptomeningeal dissemination of oligodendroglioma is very rare. We report the case of a 38-year-old Caucasian male who presented with acute hydrocephalus. 8 months before, the patient had undergone craniotomy for right frontal anaplastic oligodendroglioma, WHO grade III. By that time, there was no evidence of tumor dissemination. MRI now ruled out local tumor progression but revealed meningeal contrast enhancement along the medulla, the myelon, and the cauda equina. Repeated lumbar puncture revealed increased cerebro-spinal fluid (CSF) pressure and protein content. Malignant cells were not detectable. Surgical treatment consisted in (1) placement of an ommaya reservoir for daily CSF puncture, (2) Spinal dural biopsy confirming leptomeningeal oligodendroglioma metastasis, and (3) ventriculo-peritoneal shunt placement after CSF protein has decreased to 1500-2000 mg/l.

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