Leptomeningeal metastases typically have been a rare complication of systemic cancers. The incidence is increasing for cancers of the breast and lung, primarily because of more effective treatment modalities and longer survival. Presentation consists of multiple symptoms related to areas in the central nervous system, including the brain, cranial nerves, and spinal nerve roots. Diagnosis is made by magnetic resonance imaging with contrast enhancement and cerebral spinal fluid pathology. Treatment frequently involves combination therapy with radiation and intrathecal chemotherapy. Outcomes are poor, with short survival of six weeks to six months. Nurses play a key role in the care of patients with leptomeningeal metastases. Nursing care for this patient population includes baseline assessment and monitoring for changes in central nervous system function, symptom management, chemotherapy administration, education about the disease and treatment, identification of psychosocial issues, and assessment of coping strategies of patients and families.