Anaplastic astrocytoma presenting with simultaneous cranial nerve, brainstem and spinal leptomeningeal metastases.

To cite: McCusker MW, Looby S. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2014203958 DESCRIPTION A 54-year-old man presented with a 7-week history of morning headaches and vomiting. He described dizziness and balance problems during the preceding 6 months. Clinical examination revealed bilateral optic disc blurring and bilateral lower limb hyper-reflexia. Contrast-enhanced MRI of the brain (figure 1) and whole spine (figure 2) was performed. Biopsy of the right temporal lesion established a histological diagnosis of infiltrating WHO grade III anaplastic astrocytoma. The imaging and pathological findings confirmed the diagnosis of leptomeningeal metastases from supratentorial astrocytoma. The patient received palliative chemotherapy and died 3 months after the diagnosis. Symptomatic leptomeningeal metastasis is an uncommon complication of malignant astrocytoma, usually occuring in the context of disease recurrence or progression. Initial presentation of astrocytoma with symptomatic leptomeningeal metastases is very rare. The clinical presentation is non-specific and includes headache, confusion, seizures, papilloedema, meningism and multifocal neurological signs including cranial nerve palsies. Spinal leptomeningeal metastases may cause back pain and signs of myelopathy or polyradiculopathy.