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T2-hyperintense, non-gadolinium-enhancing, diffusion-restricted symmetrical curvilinear lesion of the anterior pons: a rare radiological pattern of leptomeningeal metastatic disease secondary to likely lung adenocarcinoma
  1. Christopher Alan Brooks1,2,
  2. Andrew Bonura3 and
  3. Roy G Beran1,4
  1. 1Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
  2. 2Neurosurgery, Liverpool Hospital, Sydney, New South Wales, Australia
  3. 3Radiology, Liverpool Hospital, Sydney, New South Wales, Australia
  4. 4Medical, Griffith University Griffith Health, Gold Coast, Queensland, Australia
  1. Correspondence to Dr Christopher Alan Brooks; brooks.christopher.alan{at}


Leptomeningeal carcinomatosis is a devastating sequelae of metastatic cancer. It has protean manifestations on imaging. An elderly woman presented to our tertiary centre with symptoms suggestive of a cerebrovascular accident. Investigations revealed no evidence of this. There was clinical, contextual and radiological evidence of an underlying neoplasm.

Magnetic resonance imaging (MRI) demonstrated evidence of a rare morphology (anterolateral pontine leptomeningeal enhancement) in the presence of a probable concomitant lung adenocarcinoma. Other reports have previously described this same neuroradiology, seemingly always in association with lung adenocarcinoma.

The purpose of this report is to highlight an unusual case and discuss its peculiarity and pathophysiology. Our patient is the latest documented of a small cohort with this constellation of clinical and neuroradiological features.

This study demonstrates the importance of differential diagnosis in stroke medicine, specifically the need to consider neoplastic phenomena in patients admitted following putative cerebrovascular events.

  • neuroimaging
  • neurooncology
  • stroke

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  • Contributors CAB authored the paper. RB was the project supervisor and provided guidance regarding the writing, and direction. AB kindly assisted with image selection and also provided guidance regarding the description of the neuroradiology, and its interpretation.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.