Miliary brain metastases from primary breast carcinoma: a case report

Excerpt

A 48-year-old female was diagnosed with left breast carcinoma in 2001, for which she underwent left mastectomy, chemotherapy and radiation therapy. In 2011, she had breast cancer recurrence with bone and lung metastases treated with different kinds of chemotherapy, hormonal therapy and radiotherapy. In August 2018, the patient presented at the emergency department with acute onset confusion, apathy, visual hallucinations and incoherent speech. Lab results were normal. An urgent brain MRI showed innumerable T2/FLAIR hyperintense nodules scattered in the cortex, gray–white matter junction, basal ganglia, thalami, cerebellum and brainstem (Fig. 1). The nodules are small (max. 5 mm) and have no perilesional edema. Some are hypointense on T1. A couple of the nodules show susceptibility artifacts on GRE T2* suggesting microbleeds or calcifications. The lesions show no diffusion restriction. After gadolinium administration, the nodules show homogeneous or ring enhancement. A diagnosis of miliary brain metastases was made and treatment was started with corticoids and cranial radiotherapy. …