Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 24-09: Intracranial & Spinal Mass Lesions + Key Features Download Section PDF Listen +++ ++ Most common sources of intracranial metastasis Lung cancer Breast cancer Skin cancer (melanoma) Kidney cancer GI tract cancer 10–15% of brain metastases are of unknown primary source Most common metastatic carcinomas to the leptomeninges are breast, lymphomas, and leukemia + Clinical Findings Download Section PDF Listen +++ ++ Intracranial metastases and primary cerebral neoplasms present similarly Intracranial pressure Focal or diffuse disturbance of cerebral function Leptomeningeal metastases cause Multifocal neurologic deficits from infiltration of nerve roots Direct invasion of the brain or spinal cord Obstructive hydrocephalus + Diagnosis Download Section PDF Listen +++ ++ Laboratory and radiology studies are the same as for primary neoplasms Lumbar puncture is needed only if carcinomatous meningitis is suspected Elevated cerebrospinal fluid pressure, pleocytosis, increased protein levels, and decreased glucose concentration are seen Malignant cells may be found on cytology In leptomeningeal metastases, CT scans show contrast enhancement in the basal cisterns or hydrocephalus without any evidence of mass lesions Gadolinium-enhanced MRI often shows leptomeningeal involvement Myelography may show deposits on multiple nerve roots + Treatment Download Section PDF Listen +++ ++ A single cerebral metastasis may be irradiated, sometimes following surgical excision Systemic immunotherapy may also be an acceptable initial option in select cases Leptomeningeal metastases receive irradiation and intrathecal methotrexate Prognosis is poor, with an approximately 10% survival at 1 year Palliative care For multiple cerebral metastases or widespread systemic disease, Stereotactic radiosurgery, whole-brain radiotherapy, or both, sometimes helps Systemic chemotherapy or immunotherapy may be options Otherwise, palliative care