Clinical Presentation, Diagnosis, and Radiological Findings of Neoplastic Meningitis

Rigakos, Georgios; Liakou, Chrysoula; Felipe, Naillid; Orkoulas-Razis, Dennis; Razis, Evangelia

doi:10.1177/107327481702400103

Cited by 12 publications

(11 citation statements)

References 108 publications

(158 reference statements)

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“…3,4 However, carcinomatous meningitis secondary to bladder cancer is rare, and to date, only 33 case reports are available in the literature. 5 The majority of these cases involved transitional cell carcinoma, as observed in our patient.…”

Section: A C C E P T E Dsupporting

confidence: 61%

Clinical Reasoning: An 81-year-old woman with confusion, weakness, and left-sided hemineglect

et al. 2020

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Section 1 An 81-year old right-handed woman presented to the emergency department with confusion, generalized weakness, and difficulty ambulating. In addition to several cardiovascular comorbidities (hypertension, hyperlipidemia, peripheral arterial disease, coronary artery disease, chronic kidney disease, and renal artery stenosis), her past medical history was significant for stage IV carcinoma of the urinary bladder. She had been in her usual state of health until one week prior to her presentation when she began experiencing generalized weakness in her legs requiring more frequent use of a walker as well as intermittent headaches and increasing forgetfulness. Two to three days prior to presentation, her husband noted that she was increasingly getting confused. On the day of presentation, she woke up disoriented and was too weak to get out of bed, prompting her husband to bring her to the ER. In the ER, she was afebrile, hypertensive (180/90 mm Hg), and tachycardic (heart rate: 120-130/minute). On mental status examination, she was intermittently oriented to time and place and unable to follow complex instructions. Her score on the Montreal Cognitive Assessment (MoCA) was 9/30. Other pertinent examination findings included left facial weakness (lower face) and left upper and lower extremity weakness (3/5). Sensory examination revealed left-sided hemineglect. The patient was unable to ambulate as she could not stand without assistance. The patient was diagnosed with stage-IV metastatic transitional cell carcinoma of the urinary bladder two years before the current admission and had gone into remission following therapy with gemcitabine and cisplatin. Eight months prior, she began immunotherapy with

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Section: A C C E P T E Dsupporting

confidence: 61%

Clinical Reasoning: An 81-year-old woman with confusion, weakness, and left-sided hemineglect

et al. 2020

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“…[ 7 10 ] Both the incidence of NM and recognition of its clinical importance has increased. Though, scientific advances, including magnetic resonance imaging (MRI), assays for tumor markers, DNA amplification procedures, flow cytometry (FCM) and immunohistochemical techniques are now available to facilitate definite diagnosis[ 11 ] the cytologic identification of malignant cells in the CSF remains the gold standard. [ 2 ] The cytological features of metastatic adenocarcinoma to CSF are presence of acinar and singly scattered tumor cells, which have a high nuclear cytoplasmic ratio, moderate to scant cytoplasm with large nucleus, irregularly clumped nuclear chromatin and have a distinct nucleoli.…”

Section: Discussionmentioning

confidence: 99%

Neoplastic meningitis: A study from a Tertiary Care Hospital from coastal India

Suresh

Kini

Basavaiah

et al. 2018

J Cytol

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Introduction:Neoplastic involvement of cerebrospinal fluid (CSF) secondary to known or unknown primaries elsewhere is a poor prognostic factor and is equivalent to stage IV disease.Aim:The aim of the study is to analyse the cytological features of neoplastic meningitis in a tertiary care center.Materials and Methods:A retrospective study of 400 consecutive CSF samples was done in the cytology laboratory of our hospital. The fluid obtained by spinal tap was sent for microbiological, biochemical and cytological evaluation. Smears that showed the presence of malignant cells were included in this study.Results:Out of 400 cases, 36 (9%) showed neoplastic meningitis. Of which, 13 cases (36%) revealed leukemic infiltration, 2 (6%) lymphomatous infiltration and 21 (58%) carcinomatous meningitis. The leukemia cases included seven cases of acute lymphoblastic leukemia and six cases of acute myeloid leukemia. Among the carcinomatous meningitis cases, eight were metastasis from carcinoma breast, six from lung carcinoma and one each from malignancies of gallbladder, stomach and retinoblastoma. Four cases were metastatic adenocarcinoma from unknown primary. Pleocytosis was a significant finding seen in 58% cases (n = 21). Elevated protein and hypoglychorrhachia was noted in 68% cases (n = 18).Conclusion:A combined diagnostic approach including biochemical, microbiological and pathological evaluation was useful in eliminating infectious meningitis and confirming neoplastic meningitis in these cases. Cytology should be performed on cerebrospinal specimens from all patients with known or suspected malignancy with meningismus. Detection of malignant cells on cytological examination of CSF is the diagnostic gold standard for neoplastic meningitis.

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Section: Neurological Emergenciesmentioning

confidence: 99%

“…Carcinomatous meningitis occurs in approximately 5% of lung cancer patients, usually late in the course of the disease [ 36 , 37 ]. Carcinomatous meningitis carries a poor prognosis with a high morbidity and survival ranging from weeks if untreated and up to 8 months with timely treatment [ 36 ]. Haematogenous dissemination is the most common mechanism of leptomeningeal tumour spread, but direct tumour extension from bone and brain lesions, and perivascular or perineural spread may also occur [ 38 ].…”

Section: Neurological Emergenciesmentioning

confidence: 99%

“…Specifically, in the spinal canal, nodular enhancement, often in the cauda equina, is a key finding suggesting carcinomatous meningitis (Fig. 10 ) [ 36 , 39 ]. Treatment should be guided by a multidisciplinary approach and includes surgery (ventriculo-peritoneal shunt or Ommaya reservoir placement), radiation therapy to high burden sites and both intrathecal and systemic chemotherapy [ 37 ].…”

Section: Neurological Emergenciesmentioning

confidence: 99%

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Imaging of urgencies and emergencies in the lung cancer patient

et al. 2018

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Lung cancer patients often experience potentially life-threatening medical urgencies and emergencies, which may be a direct or indirect result of the underlying malignancy. This pictorial review addresses the most common thoracic, neurological and musculoskeletal medical emergencies in lung cancer patients, including superior vena cava syndrome, pulmonary embolism, spontaneous pneumothorax, cardiac tamponade, massive haemoptysis, central airway obstruction, oesophagorespiratory fistula, malignant spinal cord compression, carcinomatous meningitis, cerebral herniation and pathological fracture. Emphasis is placed on imaging findings, the role of different imaging techniques and a brief discussion of epidemiology, pathophysiology and therapeutic options. Since early diagnosis is important for adequate patient management and prognosis, radiologists have a crucial role in recognising and communicating these urgencies and emergencies.Teaching points • Multiplanar multidetector computed tomography is the imaging examination of choice for thoracic urgencies and emergencies. • Magnetic resonance imaging is the imaging modality of choice for investigating central nervous system emergencies. • Urgencies and emergencies can be the initial manifestation of lung cancer. • Radiologists have a crucial role in recognising and in communicating these urgencies/emergencies.

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Clinical Presentation, Diagnosis, and Radiological Findings of Neoplastic Meningitis

Cited by 12 publications

References 108 publications

Clinical Reasoning: An 81-year-old woman with confusion, weakness, and left-sided hemineglect

Clinical Reasoning: An 81-year-old woman with confusion, weakness, and left-sided hemineglect

Neoplastic meningitis: A study from a Tertiary Care Hospital from coastal India

Imaging of urgencies and emergencies in the lung cancer patient

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