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Table 2. Most common clinical manifestations of LM
Headache Related to an increased intracranial pressure, blockage of the CSF flow and obstructive hydrocephalus
Spinal symptoms Lower motor neuron weakness, sensory loss, radicular and back/neck pain, bladder, sexual and bowel
dysfunctions
Cranial nerve palsies Diplopia and visual impairment (II), ophthalmoparesis (III-IV-VI), hearing loss (VIII), facial weakness
(VII), trigeminal sensory impairment (V), dysphagia (XI-X)
Impaired consciousness Mood and mental changes (especially in case of encephalopathy), seizures
Gait disturbances Due to cerebellar (coupled with nystagmus, dysmetria, dysarthria) os sensitive ataxia
Nausea/vomiting involvement of the vestibular nerve and floor of the fourth ventricle floor
CSF: cerebrospinal fluid; LM: leptomeningeal metastases

Figure 1. Linear enhancement of left temporal sulci from epidermal growth factor receptor mutated non-small-cell lung cancer

scorecard, and discordance for the rating of single items at baseline and follow-up was observed. A new
[56]
simplified RANO-LM score is now under development . Similarly, the European Association for Neuro-
Oncology and the European Society of Medical Oncology (EANO-ESMO) have proposed a classification
of the radiological findings in LM: linear lesions (type A), nodular lesions (type B), both linear and
nodular lesions (type C), absence of enhancing lesions in presence of hydrocephalus (type D) . Overall,
[57]
both LANO and EANO/ESMO groups have proposed a tentative diagnostic workup that include clinical
symptoms, imaging, and CSF cytology for diagnosis and assessment of treatment response for LM; however,
a major issue is to define measurable versus non-measurable lesions, and changes in the measurement that
qualify for response. Due to these caveats, their application in daily clinical practice remains limited.