Abstract Details

Title Differential Diagnosis of Leptomeningeal Enhancement in the Pediatric Population

Topic General Neurology

Presentation(s) P4 - Poster Session 4 (11:45 AM-12:45 PM)

Poster/Presentation
Number 4-010

Objective

To determine the differential diagnosis of leptomeningeal enhancement (LME) and compare the rates of LME by diagnosis in children

Background LME is a radiologic manifestation seen in various central nervous system diseases, including malignancies, infections, and neuroimmunological disorders. The presence of LME has been estimated at different frequencies in various neuroimmunological disorders. However, the relationship between LME in the pediatric population and the prevalence of the associated diseases remains unknown.

Design/Methods A retrospective chart review of pediatric patients with new leptomeningeal enhancement (LME) on brain MRI at Children’s Healthcare of Atlanta between January 1-December 31, 2022 was performed. Data was collected on age at detection of LME, patient demographics, diagnosis, and ancillary tests including serum and cerebrospinal fluid (CSF) studies. Statistical analysis was performed using R CRAN.

Results Sixty patients were included with a mean age of 7.5 (standard deviation (SD): 6.0) years at the time of LME. Etiologies for LME, from highest to lowest, were as follows: infectious (N=28, 47%), oncologic (N=16, 27%), neuroinflammation (N=5, 8%, including N=3, 5% with anti-MOG antibody associated disorder (-MOGAD)), and other (N=14, =24%). The types of infections included: group A streptococcus, streptococcus anginosus, and listeria. The types of oncologic disorders included: rhabdomyosarcoma, diffuse midline glioma, acute lymphocytic or promyelocytic leukemia, melanoma, pilocytic astrocytoma, diffuse leptomeningeal glioneuronal tumor, myxopapillary ependymoma, choroid plexus carcinoma, and high grade glioma. Other etiologies included: hemiplegic migraine, seizures, hypoxic ischemic encephalopathy, moyamoya, Sturge Weber, and unknown. Median CSF WBC count was highest in infectious (308, interquartile range-IQR 110-962), as compared to inflammatory (66.5, IQR 163.5-258) and oncologic cases (5.5, IQR 1.0-16.0).

Conclusions The differential diagnosis for LME is broad, but most commonly includes infection, followed by oncologic conditions, and then inflammatory conditions. MOGAD is the most common neuroinflammatory cause of LME and should be considered in children.

Authors/Disclosures
Gabriela A. Bou, MD (Emory University School of Medicine) PRESENTER	Dr. Bou has nothing to disclose.
Adam Goldman-Yassen	Adam Goldman-Yassen has nothing to disclose.
Morgan Morris (Emory University)	Morgan Morris has nothing to disclose.
Monideep Dutt, MD (CHILDRENS HEALTHCARE OF ATLANTA, Department of Neurology)	Dr. Dutt has nothing to disclose.
Phaethon Philbrook	No disclosure on file
Grace Gombolay, MD, FAAN (Emory University/Children'S Healthcare of Atlanta)	Dr. Gombolay has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. The institution of Dr. Gombolay has received research support from CDC. The institution of Dr. Gombolay has received research support from NIH. Dr. Gombolay has a non-compensated relationship as a Board of Trustee with National MS Society -Georgia chapter that is relevant to AAN interests or activities.

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