Neoplastic meningitis

Background

  • Also known as Leptomeningeal Carcinomatosis or leptomeningeal metastasis (LM)
  • Uncommon and late complication of solid tumors and hematological cancers, approximately 5-8% and 5-15% respectively
  • Most common primary tumors associated with LM are breast, lung, and melanoma
  • Commonly misdiagnosed due to symptoms mimicking infectious meningitis and chronic headache

Pathophysiology

  • Multiple routes tumor cells can gain access to CSF
  • Most commonly thought to be through hematogenous spread via arachnoid vessels or direct extension from brain parenchyma

Clinical Features

Differential Diagnosis

Headache

Common

Killers

Maimers

Others

Aseptic Meningitis

Evaluation

Meningeal carcinomatosis on contrast-enhanced axial T1-weighted MRI.

Workup

  • CT brain is not sensitive or specific, may show intracranial mass
  • MRI brain and spine with contrast preferred (70% sensitivity, 77-100% specificity)
    • Leptomeningeal enhancement
    • Hydrocephalus
    • Subependymal nodules or deposits
  • Lumbar Puncture-mainly to rule out infectious etiology in ED
    • Elevated opening pressure
    • Glucose, protein, cell count and cytology can be abnormal
    • Malignant cells on CSF smear

Diagnosis

  • Leptomeningeal enhancement or lesions on MRI
  • Malignant cells on CSF smear

Management

Disposition

  • Admit

See Also

External Links

References

  • Shin Ahn, Kyung Soo Lim, "Three Cases of Neoplastic Meningitis Initially Diagnosed with Infectious Meningitis in Emergency Department", Case Reports in Emergency Medicine, vol. 2013, Article ID 561475, 4 pages, 2013.
  • Batool A, Kasi A. Leptomeningeal Carcinomatosis. [Updated 2020 Apr 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499862/
  • Cooney DR, Cooney NL. Meningeal carcinomatosis diagnosed during stroke evaluation in the emergency department. Int J Emerg Med. 2011;4:52. Published 2011 Aug 9. doi:10.1186/1865-1380-4-52