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

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