Dural metastasis

Additional clinical history: The patient has a history of breast cancer.


Findings

Axial FLAIR, axial T1 W pre- and post-contrast and coronal T1 W post-contrast images through the posterior fossa demonstrate an enhancing primarily extra axial mass which appears dural-based with possible extension into the underlyingcerebellar parenchyma. There was also regional mass effect resulting in acute hydrocephalic changes, inferior tonsillar herniation and effacement of the pontomedullary junction.

Differential Diagnosis:
- Meningioma
- Schwannoma
- Sarcoidosis
- Primary meningeal lymphoma
- Leptomeningeal metastases
- Acute cerebellitis
- Dysplastic cerebellar gangliocytoma


Diagnosis: Metastatic breast cancer


Key points (Posterior fossa extra-axial metastatic disease)

Adult population.
Clinical presentation may include headache, 7th and 8th nerve palsies, polycranial neuropathy, vertigo.
Most common tumors to metastasize to this area include breast, lung and melanoma.
Diagnosed with increasing frequency due to improved cancer survival.
Poor prognosis.


Key radiologic features

Enhancing lesion with meningeal and/or calvarial destruction.
Smooth thickening, nodularity, loculation, lobulation, fungating masses.
May extend into the IAC resembling acoustic tumor.