LEPTOMENINGEAL DISEASE (LMD)

Expert Evaluation • Advanced Diagnostics • Multidisciplinary CNS Metastasis Care

Overview

Leptomeningeal disease (LMD)—also known as leptomeningeal carcinomatosis or leptomeningeal metastases—occurs when cancer cells spread into the cerebrospinal fluid (CSF) and the delicate layers surrounding the brain and spinal cord. It is a complex condition requiring rapid diagnosis, coordinated multidisciplinary care, and thoughtful guidance on treatment options.

As Director of Northwell Health’s Brain & Spine Metastasis Program at Lenox Hill Hospital, Dr. Randy S. D’Amicoevaluates and manages patients with suspected or confirmed LMD. He works closely with neuro-oncology, radiation oncology, neuroradiology, and supportive care teams to provide clarity, timely diagnostics, and modern treatment strategies for patients and families navigating this challenging diagnosis.

Common Symptoms

LMD can cause a wide range of neurological symptoms depending on where cancer cells settle within the CSF pathways:

Brain-Related Symptoms

  • Headaches

  • Nausea or vomiting

  • Cognitive or personality changes

  • Difficulty walking or imbalance

  • Visual changes

Spinal Symptoms

  • Lower back pain

  • Leg weakness or numbness

  • Loss of bladder or bowel control

  • Pain that radiates down the arms or legs

Cranial Nerve Symptoms

  • Facial weakness

  • Hearing changes

  • Double vision

  • Difficulty swallowing

Symptoms may progress quickly and should be evaluated promptly.

How Leptomeningeal Disease Is Diagnosed

1. MRI of the Brain and Spine

High-quality MRI with contrast often reveals characteristic patterns of enhancement along the brain or spinal cord.

2. Cerebrospinal Fluid (CSF) Analysis

A lumbar puncture is used to analyze CSF for:

  • Malignant cells

  • Tumor markers

  • Flow cytometry

  • Molecular profiling (when needed)

3. Circulating Tumor Cell (CTC) Assays

Dr. D’Amico frequently collaborates with neuro-oncology to use advanced CSF diagnostics—including CTC quantification—which may improve diagnostic accuracy and help track treatment response.

4. Whole-Body Imaging

(PET/CT or CT chest/abdomen/pelvis) to evaluate systemic disease status.

Early, accurate diagnosis allows for faster initiation of appropriate therapy.

Treatment Options

Management of leptomeningeal disease typically involves a combination of the following:

Radiation Therapy

Used for symptomatic areas, spinal cord compression, or bulky nodular disease.

Systemic Therapy

Depending on the primary cancer type, patients may receive:

  • Targeted therapies (EGFR, ALK, BRAF, HER2, KRAS, etc.)

  • Immunotherapy

  • Chemotherapy
    Some modern agents reach the CSF more effectively.

Intrathecal Therapy

In select cases, medications can be delivered directly into the CSF through lumbar puncture or an Ommaya reservoir.

Surgery (Selective Cases)

Surgery is not typically used to treat LMD itself, but it may be considered if:

  • A patient requires tissue diagnosis

  • There is hydrocephalus requiring shunt placement

  • Symptomatic focal tumor nodules cause mass effect

Supportive and Palliative Care

Symptom control, mobility support, and quality-of-life planning are essential components of comprehensive care.

Dr. D’Amico partners closely with neuro-oncology to ensure that every patient receives evidence-based, individualized treatment recommendations aligned with their goals and disease biology.

When to Seek a Second Opinion

A second opinion is strongly recommended when:

  • MRI suggests possible leptomeningeal spread

  • CSF results are unclear or inconsistent

  • Symptoms progress despite treatment

  • There is uncertainty between treatment-related changes vs. true progression

  • Patients need guidance on targeted therapies, immunotherapy, or trial eligibility

  • There is a desire for clear, multidisciplinary care coordination

Dr. D’Amico offers timely second opinions, especially for new or evolving neurological symptoms.

Serving New York City & the Tri-State Area

Patients with leptomeningeal disease are evaluated at Lenox Hill Hospital (100 E 77th St, New York, NY 10075), located on the Upper East Side of Manhattan. Care is accessible for patients from:

  • Manhattan

  • Brooklyn

  • Queens

  • The Bronx

  • Long Island

  • Westchester

  • Northern New Jersey

Urgent consultations are available for patients with rapidly progressing symptoms or diagnostic uncertainty.

Next Steps

If you or a loved one has been diagnosed with leptomeningeal disease:

  • Request a Consultation

  • Seek a Second Opinion

  • Refer a Patient

  • Return to the Conditions Treated overview