PMC9801098_01
Leptomeningeal enhancement on post contrast T1 MRI sequences (A+C using dark blood sequences). A Leptomeningeal enhancement around the midbrain, compared to B from 10 months prior. C Leptomeningeal enhancement around the medulla and pons. D. Enhancement of the cauda equina with adherence to the anterior spine.
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Repeat brain and whole spine MRI with gadolinium contrast revealed diffuse leptomeningeal enhancement particularly around the pons and cerebral peduncles and posterior fossa contents, this extended to involve the leptomeninges of the spine including the nerve roots in the cauda equina which were adhered anteriorly (Fig. 1). Retrospective review of the brain MRI 10 months prior to diagnosis demonstrated early leptomeningeal enhancement around the midbrain (Fig. 1), although this had progressed substantially by the time of his admission.