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Case Reports
. 2024 Dec 24;103(12):e210100.
doi: 10.1212/WNL.0000000000210100. Epub 2024 Nov 25.

Clinical Reasoning: A 63-Year-Old Man With Progressive Multicranial Neuropathy and Leptomeningeal Enhancement

Arens Taga  1 , Carlos G Romo  1 , Sharika Rajan  1 , Doris D M Lin  1 , Grace Tobin  1 , Arun Venkatesan  1 , Carlos A Pardo  1
Affiliations
Case Reports

Clinical Reasoning: A 63-Year-Old Man With Progressive Multicranial Neuropathy and Leptomeningeal Enhancement

Arens Taga et al. Neurology. .

Abstract

A 63-year-old man, with a history of melanoma and basal cell carcinoma, presented with progressive right-sided facial numbness, vertical diplopia, and headache. Brain MRI revealed leptomeningeal enhancement of multiple cranial nerves and an enhancing mass-like lesion along the anterolateral surface of the pons and midbrain. Subsequent brain biopsy demonstrated the final diagnosis. This case highlights the broad differential diagnosis of leptomeningeal disease, emphasizing the role of specific clinical, laboratory, and imaging cues in guiding clinical reasoning.

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Conflict of interest statement

A. Taga is supported by the NIH (National Institute of Neurological Disorders and Stroke) through an administrative supplement to award R25NS065729. C.A. Pardo is supported by NIH R01 NS123712. The content is solely the author's responsibility and does not necessarily represent the views of the NIH. Go to Neurology.org/N for full disclosures.

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