What are leptomeningeal metastases?

Leptomeningeal metastases mean cancer cells have spread to the thin tissue layers covering the brain and spinal cord (the leptomeninges). The leptomeninges are part of the brain meninges. 

Leptomeningeal metastases are also called:

  • carcinomatosis meningitis
  • leptomeningeal disease
  • leptomeningeal carcinomatosis
  • neoplastic meningitis
Diagram showing the meninges, brain and spinal cord

How it happens

Cancer cells can reach the meninges by travelling in the bloodstream from a cancer somewhere else in the body. Or they might spread from a secondary cancer that has already developed in the brain.

A secondary cancer happens when:

  • cancer cells break away from where the cancer first started (the primary cancer)
  • spreads to another part of the body

A secondary cancer is also called metastases.

How common are leptomeningeal metastases?

Between 5 to 10 out of every 100 people (5 to 10%) with solid tumours Open a glossary item might develop leptomeningeal metastases. It is most common in people with breast or lung cancer or melanoma skin cancer. In people with blood cancer, 5 to 15 out of every 100 people (5 to 15%) might develop leptomeningeal metastases.

You could talk to your cancer specialist or specialist nurse if you are worried about this.


Cancer cells in the covering of the brain can cause a range of symptoms, including:

  • headaches
  • changes to your sight, such as double vision or loss of sight
  • confusion
  • weakness
  • seizures (fits)
  • feeling sick (nausea)
  • vomiting
  • hearing changes
  • facial drooping
  • pain in your lower back, legs or neck
  • mental changes such as mood and behaviour
  • changes to how you walk
  • numbness or weakness of one or both legs and of your bottom
  • problems passing wee (urine) or poo (stool)


It can be difficult to diagnose leptomeningeal metastases. It might show up on an MRI scan, or cancer cells might be found in fluid taken from the spine by a lumbar puncture. 

A lumbar puncture is a test to check the fluid that circulates around the brain and spinal cord. The lumbar puncture needle goes through the skin into the small of your back and into the space around the spinal cord. 


Some people may not be able to have treatment for their cancer because they are too unwell. You will have medicine to control any pain or other side effects you may be getting. 


Most people worry about their outlook (prognosis) when they have a secondary cancer. Your individual outlook depends on many factors including:

  • whether the cancer has spread to more than one part of your body
  • how quickly it is growing
  • how it responds to treatment

Treatment for leptomeningeal metastases aims to control the growth of the cancer and relieve symptoms. Treatment might be able to control the cancer cells in the meninges for some months. With newer targeted cancer drugs, this might possibly be more than a year for certain cancers. 

It is difficult for doctors to predict someone’s outlook, and this uncertainty can be hard to deal with.

  • An overview of leptomeningeal disease

    T Nguyen and others

    Annals of Palliative Medicine, 2021 January. Volume 10, Issue 1, Pages: 909 to 922

  • Leptomeningeal Metastases: New Opportunities in the Modern Era

    J Wilcox and others

    Neurotherapeutics, 2022 October. Volume 19, Issue 6, Pages: 1782 to 1798

  • How we treat patients with leptomeningeal metastases
    E L Rhun and others
    ESMO Open, 2019.

  • Treatment of leptomeningeal disease from solid tumors

    A Demopoulos and others

    UpToDate website

    Accessed August 2023

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact patientinformation@cancer.org.uk with details of the particular issue you are interested in if you need additional references for this information.

Last reviewed: 
30 Aug 2023
Next review due: 
30 Aug 2026

Related links