LAUSR

considered including localized meningitis, vasculitis, and brain tumor. On admission, neurologic examination was significant for right multiple cranial nerves palsy (V, VI, VII, VIII, IX and X). CSF analysis was unremarkable except for mildly increased protein level (1296.00 mg/L). The examination of CSF cytology was negative. No indication for tuberculosis and bacterial infection by staining and culture in CSF. Results of pathogenic examination and paraneoplastic autoantibody testing in serum and CSF were all negative. Thoracic and abdominal result of 18F-FDG PET/CT scan as well as colon and gastric endoscopy were both insignificant. Cranial MRI showed gyrus-like and patching lesion on the left frontal lobe with localized meningeal enhancement (Fig. 1a–c). The MRI findings were not specific enough for discrimination of neoplastic and inflammatory disease. 1H-MRS revealed decreased peaks of NAA and Cr and an increased peak of Cho within the lesion. The lesion has a lower ratio of NAA/Cr (0.833) and higher ratio of Cho/Cr (1.77) and Cho/NAA (2.12) compared to the right hemisphere, suggesting of the presence of malignant lesion (Fig. 1d). We conducted meningeal biopsy on the left frontal lobe. Microscopic histopathological examination of the surgical specimen from meninge revealed atypical cells which supported differentiated adenocarcinoma (Fig. 1f). Immunohistochemically, these tumor cells were strongly positive for AE1/3, CK7 and TTF-1 (Fig. 1g–i), supporting the diagnosis of metastatic adenocarcinoma originating from the lung. The patient received radiotherapy after diagnosis. To the Editor,