Sugar Coating

sugar coating spinal metastases

This 43 year old patient presented with a cauda-equina syndrome from an intraspinal metastasis (not shown). There was a history of melanoma excision 6 years previously with no interval symptoms.

Post contrast MRI demonstrates so called “sugar coating” or zuckerguss (German for sugar icing) of the lower portions of the spinal cord in keeping with leptomeningeal metastases.

Possible primaries include primary intracerebral malignancies (medulloblastoma, PNET, ependymoma and GBM) as well as, more commonly, widespread metastatic disease (breast, lung and melanoma – as in this case).

References:
eMedicine

Credit: Dr Frank Gaillard