Case 1: A 15-year-old male presented with headache, vomiting, and signs of raised intracranial tension for a 4-month duration. MRI showed Considering the imaging appearance of mass-like meningeal deposits along the CP angles bilaterally (Figure 1) with diffuse nodular meningeal enhancement along the brain and spine, the patient underwent biopsy, which showed DLGNT with high-grade histological features.

DLGNT: Solid, mass-like meningeal deposits

In rapidly growing high-grade tumours (2), coalescence of multiple smaller meningeal lesions results in the formation of conglomerate deposits along the basal cisterns and subpial spaces of the cord.

Case 2: A 23-year-old male presented with long standing hydrocephalus with few suspicious meningeal nodular enhancing lesions on MRI, initially treated as tuberculosis. An MRI was done (Figure 2), which showed hydrocephalus with CSF signal intensity cystic expansion of the basal cisterns in the brain, with similar cystic lesions in the cord as well. A meningeal biopsy was performed in view of the poor response to therapy, which showed a diffuse low-grade cellular tumour with both glial and dysplastic neuronal elements and infiltrating the subarachnoid spaces. 

DLGNT: Widespread subarachnoid space cystic infiltration

In slow-growing low-grade tumours, coalescence of multiple smaller meningeal lesions results in the formation of conglomerate deposits along the basal cisterns and subpial spaces of the cord. A peculiar feature of this case was T2WI hyperintense cystic sulcal-subarachnoid space enlargement in both the supratentorial region and the posterior fossa with nodular leptomeningeal-enhancement lesion in the depths of the sulci and subarachnoid spaces. It is important to differentiate this pattern from the racemose form of neurocysticercosis (4), in which the cysts are usually large enough to cause some form of mass effect on adjacent structures. 

Case 3: An 11-year-old female presented with recurrent falls; an MRI was done (Figure 3), which showed the classically described small subpial cysts with widespread nodular leptomeningeal thickening and enhancement in the brain and spine; a biopsy of the meningeal lesion was performed, which revealed DLGNT.

DLGNT: Subpial cysts with nodular meningeal thickening and enhancement

This appearance is probably the more common and frequently described variety (3), with the current case showing widespread infiltration of supra and infratentorial CSF spaces with tiny subpial cysts