Dural metastases
Updates to Article Attributes
Body
was changed:
Dural or pachymeningeal metastases are a relatively common cause of dural masses, although they are less common than brain metastases. They can occur both within the spine and intracranially - this article is focussed on intracranial dural masses.
Clinical presentation
Patients my present headache, fatigue, confusion and focal neurology such as contralateral motor and sensory changes 4. A significant number (~20%) may be clinically occult.
Pathology
There are four mechanisms by which intracranial dural metastases are thought to occur 2:
- direct extension from skull metastases
- retrograde seeding through the vertebral venous plexus
- haematogenous seeding
- lymphatic seeding
The primary malignancies that frequently cause dural metatases include (in descending order of frequency) 1,2:
-
breast cancer
(most common) - prostate cancer
- lung cancer
- head and neck cancers
- haematological cancers
- neuroblastoma
Radiographic features
MRI
Dural metastases may be diffuse or present as a focal mass. Typical signal characteristics:
- T2: iso/hyperintense
- T1C+: vivid enhancement 4
Differential diagnosis
- other dural masses
- other causes for dural enhancement
- leptomeningeal metastases
-<p><strong>Dural</strong> or <strong>pachymeningeal metastases</strong> are a relatively common cause of <a title="Dural masses" href="/articles/dural-masses">dural masses</a>, although they are less common than <a title="Brain metastases" href="/articles/brain-metastases">brain metastases</a>. They can occur both within the spine and intracranially - this article is focussed on intracranial dural masses. </p><h4>Clinical presentation</h4><p>Patients my present headache, fatigue, confusion and focal neurology such as contralateral motor and sensory changes <sup>4</sup>. A significant number (~20%) may be clinically occult. </p><h4>Pathology</h4><p>There are four mechanisms by which intracranial dural metastases are thought to occur <sup>2</sup>:</p><ul>-<li>direct extension from <a title="Skull metastases" href="/articles/skull-metastases">skull metastases</a>- +<p><strong>Dural</strong> or <strong>pachymeningeal metastases</strong> are a relatively common cause of <a href="/articles/dural-masses">dural masses</a>, although they are less common than <a href="/articles/brain-metastases">brain metastases</a>. They can occur both within the spine and intracranially - this article is focussed on intracranial dural masses. </p><h4>Clinical presentation</h4><p>Patients my present headache, fatigue, confusion and focal neurology such as contralateral motor and sensory changes <sup>4</sup>. A significant number (~20%) may be clinically occult. </p><h4>Pathology</h4><p>There are four mechanisms by which intracranial dural metastases are thought to occur <sup>2</sup>:</p><ul>
- +<li>direct extension from <a href="/articles/skull-metastases">skull metastases</a>
-<li>retrograde seeding through the <a title="Vertebral venous plexus" href="/articles/vertebral-venous-plexus-1">vertebral venous plexus</a>- +<li>retrograde seeding through the <a href="/articles/vertebral-venous-plexus-1">vertebral venous plexus</a>
-</ul><p>The primary malignancies that frequently cause dural metatases include <sup>1,2</sup>:</p><ul>-<li>-<a title="breast cancer" href="/articles/breast-cancer">breast cancer</a> (most common)</li>-<li><a title="prostate cancer" href="/articles/prostatic-carcinoma-1">prostate cancer</a></li>-<li><a title="Lung cancer" href="/articles/lung-cancer-3">lung cancer</a></li>- +</ul><p>The primary malignancies that frequently cause dural metatases include (in descending order of frequency) <sup>1,2</sup>:</p><ul>
- +<li><a href="/articles/breast-cancer">breast cancer</a></li>
- +<li><a href="/articles/prostatic-carcinoma-1">prostate cancer</a></li>
- +<li><a href="/articles/lung-cancer-3">lung cancer</a></li>
-<li><a title="Neuroblastoma" href="/articles/neuroblastoma">neuroblastoma</a></li>- +<li><a href="/articles/neuroblastoma">neuroblastoma</a></li>
-<li>other <a title="Dural masses" href="/articles/dural-masses">dural masses</a>- +<li>other <a href="/articles/dural-masses">dural masses</a>
-<li>other causes for <a title="Dural enhancement" href="/articles/dural-enhancement">dural enhancement</a>- +<li>other causes for <a href="/articles/dural-enhancement">dural enhancement</a>
-<li><a title="Leptomeningeal metastases" href="/articles/leptomeningeal-metastases">leptomeningeal metastases</a></li>- +<li><a href="/articles/leptomeningeal-metastases">leptomeningeal metastases</a></li>
References changed:
- 1. Nayak L, Abrey L, Iwamoto F. Intracranial Dural Metastases. Cancer. 2009;115(9):1947-53. <a href="https://doi.org/10.1002/cncr.24203">doi:10.1002/cncr.24203</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/19241421">Pubmed</a>
- 2. Jeffrey Raizer, Lauren E. Abrey. Brain Metastases. (2007) ISBN: 9780387692210 - <a href="http://books.google.com/books?vid=ISBN9780387692210">Google Books</a>
- 3. Kleinschmidt-DeMasters B. Dural Metastases. A Retrospective Surgical and Autopsy Series. Arch Pathol Lab Med. 2001;125(7):880-7. <a href="https://doi.org/10.5858/2001-125-0880-DM">doi:10.5858/2001-125-0880-DM</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/11419971">Pubmed</a>
- 4. David Schiff, Santosh Kesari, Patrick Y. Wen. Cancer Neurology in Clinical Practice. (2008) ISBN: 9781588299833 - <a href="http://books.google.com/books?vid=ISBN9781588299833">Google Books</a>
Systems changed:
- Central Nervous System
Images Changes:
Image ( create )
Image 1 MRI (T1 C+ fat sat) ( create )
Image 3 MRI (T1 C+) ( create )
Image 4 MRI (T1 C+) ( create )
Image 5 MRI (T1 C+) ( create )
Image 6 MRI (T1 C+) ( create )
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