Stroke associated with microvascular tumoral infiltration in a patient with metastatic breast cancer

Leptomeningeal carcinomatosis is a form of advanced metastatic disease conferring poor prognosis, most commonly associated with melanoma, small cell lung cancer, and breast cancer. In rare cases it has been shown to be associated with stroke thought to be related to vasculopathy caused by tumoral infiltration of cerebral vasculature. We present a case of acute cerebellar infarction in a patient with metastatic breast cancer complicated by leptomeningeal carcinomatosis, admitted for worsening metastatic disease. We include images clearly demonstrating interval development of diffusion restriction at a site of macroscopically stable leptomeningeal disease, in the setting of new onset focal neurologic deficits clinically consistent with acute stroke.