Differential Diagnosis for Leptomeningeal Enhancement
- Single Most Likely Diagnosis
- Meningitis (infectious or inflammatory): This is the most common cause of leptomeningeal enhancement, which can be due to bacterial, viral, or fungal infections, as well as inflammatory conditions such as sarcoidosis or rheumatoid arthritis.
- Other Likely Diagnoses
- Leptomeningeal metastases: Cancer cells can spread to the leptomeninges, causing enhancement on imaging, particularly in patients with a history of cancer.
- Neurosarcoidosis: This condition can cause leptomeningeal enhancement due to granulomatous inflammation.
- Multiple sclerosis: Although more commonly associated with white matter lesions, multiple sclerosis can also cause leptomeningeal enhancement.
- Do Not Miss Diagnoses
- Subarachnoid hemorrhage: This is a medical emergency that can cause leptomeningeal enhancement, and prompt diagnosis is crucial for treatment.
- CNS vasculitis: Inflammatory conditions affecting the blood vessels of the central nervous system can cause leptomeningeal enhancement and require urgent treatment.
- Lyme disease: Neuroborreliosis, the neurological manifestation of Lyme disease, can cause leptomeningeal enhancement and requires prompt antibiotic treatment.
- Rare Diagnoses
- Neurosyphilis: This condition can cause leptomeningeal enhancement, particularly in patients with a history of syphilis.
- Cysticercosis: A parasitic infection caused by the pork tapeworm, which can cause leptomeningeal enhancement.
- Histiocytosis: A rare condition characterized by abnormal proliferation of histiocytes, which can cause leptomeningeal enhancement.
- Lymphomatosis cerebri: A rare condition characterized by diffuse infiltration of the brain and leptomeninges by lymphoma cells.