Rare Presentation of Miliary Brain Metastasis in Absence of TypicallyAssociated Mutation

Lung cancer frequently presents with metastasis to the brain. Previously multiple metastases to the brain, described as miliary metastasis, have been reported with lung cancer and more commonly adenocarcinoma subtype. Various gene mutations involving exon 19, exon 20 and exon 21 have been reported with such metastasis. Though the prognosis is poor it is useful to identify such spread in order to tailor the treatment plan for a patient. We present a case of miliary metastasis to the brain in a patient with Grade IVa lung cancer presenting with confusion and speech difficulties.