Multiple infarctions in a woman with carcinomatous meningitis infiltrating basal cerebral arteries

Case report: A 57-year-old woman developed cytologically proven carcinomatous meningitis due to cancer of unknown primary. Repeated cerebral CT and MRI scans with arterial angiography revealed contrast agent enhancement of the meninges and multiple cerebral infarctions, especially bilateral anterior cerebral artery infarcts. Spinal MRI indicated an involvement of the cauda and the spinal meninges as well. Transcranial contrast ultrasound revealed segmental flow acceleration in all basal cerebral arteries compatible with vasospasm or tumor cell infiltration/inflammation. Therapy with intrathecal methotrexate (MTX…