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Images in clinical medicine. Meningeal carcinomatosis in breast cancer.

Figure 1. A 49-year-old woman with progressive metastatic breast cancer despite aggressive chemotherapy was hospitalized with slurred speech, clumsiness of the right hand, and increasing lethargy. Examination revealed that the patient was somnolent but arousable, with dysarthria and dysmetria of the right arm. A cranial magnetic resonance image with gadolinium contrast medium (Panel A) demonstrated leptomeningeal enhancement, which was most prominent over the cerebellum (arrows). Examination of the cerebrospinal fluid revealed an elevated protein concentration (121 mg per deciliter; normal range, 12 to 45), with normal glucose and glutamine concentrations. A Gram's stain was negative for microorganisms. Cytologic analysis (Panel . . .