carcinomatous meningitis (leptomeningeal metastases)
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Etiology
- metastatic solid tumor
- clinical evidence is present in ~8%
- prevalence as high as 19% in autopsies
- adenocarcinoma of breast & melanoma most common
- lymphoma/leukemia
Pathology
- three patterns
- diffuse coating of leptomeninges by tumor cells
- nodular growth on meninges or nerve root
- plaquelike metastases with cells in subarachnoid space extending into Virchow-Robin spaces
- hydrocephalus, communicating hydrocephalus
- encephalopathy
Clinical manifestations
- headache or spine pain
- cranial nerve pain or spinal radicular pain
- mental status changes
- focal neurological deficit from associated intracranial metastases
Laboratory
- cerebrospinal fluid (CSF)
- findings of inflammatory meningitis are negative
- lymphocytic pleocytosis
- elevated CSF protein
- normal to low CSF glucose
- oligoclonal increase of IgG sometimes
Radiology
- magnetic resonance imaging (MRI) with gadolinium enhancement
- diffuse meningeal enhancement (brain, spinal cord, nerve roots)
- nodular tumor deposits on meninges
- ventricular enlargement, communicating hydrocephalus
Management
- chemotherapy followed by radiation therapy[2]
- methotrexate & cytarabine
- intrathecal chemotherapy[1]
- focal beam radiotherapy
- ventriculoperitoneal shunt for hydrocephalus
More general terms
References
- ↑ 1.0 1.1 Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 2406-7
- ↑ 2.0 2.1 Medical Knowledge Self Assessment Program (MKSAP) 14, American College of Physicians, Philadelphia 2006
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022