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Diagnosis and management of leptomeningeal disease secondary to grade IV astrocytic glioma
  1. Chon Meng Lam,
  2. Anthony Lisacek-Kiosoglous,
  3. Elena Paleacu and
  4. Elin Jones
  1. Hywel Dda University Health Board, Carmarthen, UK
  1. Correspondence to Dr Elin Jones; elin.m.jones{at}; Dr Chon Meng Lam; chonmenglam{at}


A man in his mid-40s presented to hospital with confusion, headache and feeling generally unwell. He had had a total resection of a grade IV astrocytic glioma 1 year prior. Initial observations, blood tests and CT head scan were unremarkable for acute features to explain the patient’s presentation. However, an MRI head scan on this admission demonstrated a clear communicating hydrocephalus with new abnormal leptomeningeal enhancement, consistent with leptomeningeal metastatic infiltration by glioma. Lumbar puncture cytology and biochemistry supported this interpretation. As a small district general hospital in rural Wales, we discuss the experience of diagnosis and coordination of specialist input from a multidisciplinary team. We share the challenges of managing leptomeningeal disease in the COVID-19 pandemic, in the context of the additional risks this presents with chemotherapy-induced immunosuppression.

  • CNS cancer
  • Neurosurgery

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  • Contributors CML: planning and conducting case report, collecting data from the case, reviewing of literature and drafting manuscript. AL-K: had a leading role in making the revisions to manuscript and played a leading role in responding to reviewers comments. EP: collecting and reviewing radiological images from the case, senior doctor involved in case, contribution to planning of manuscript content. EJ: consultant responsible for care of the patient, overall management of patient’s condition and insight into patient’s care.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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