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Meningeal Carcinomatosis

Brain Tumor Meningeal Carcinomatosis


Presentation

  • Patients usually have a known underlying malignancy, hut primary presentation can be with symptoms of meningeal involvement. The cases are reported of two patients who presented with sensorineural hearing loss.[researchers.mq.edu.au]
  • It is associated with myriad of presentations, which often make diagnosis difficult.[cjhr.org]
  • At presentation, 25% (29/118) of patients presented with metastasis of the leptomeninges as the first presentation of metastatic disease ( 7 ).[spandidos-publications.com]
  • We present a case whose primary presentation was as a carcinomatous meningitis that was subsequently found to be secondary to a gallbladder primary.[jcytol.org]
  • We present a case of acute bilateral blindness secondary to ovarian adenocarcinoma with meningeal infiltration. Case report A 50-year-old woman presented in May 2000 with abdominal distention and ill-defined abdominal pain.[nature.com]
Pleural Effusion
  • Last, when computed tomography chest and abdomen was performed to see metastasis to other organs it showed mild irregular septal thickening suggestive lymphangitis carcinomatosis with skeletal metastasis with left pleural effusion.[cjhr.org]
Neck Pain
  • Three months later, he was readmitted for evaluation of headaches, neck pain and numbness of the left arm.[healio.com]
  • The clinical presentations associated with MC are symptoms mainly due to increased intracranial pressure such as headache, nausea and vomiting, neck pain as well as confusion.[bmcneurol.biomedcentral.com]
  • In early March 2014 she developed headache and neck pain.[pancreas.imedpub.com]
  • M is hypertensive (BP 158/95 mm Hg), but he's afebrile and denies neck pain or stiffness or changes in vision. A Romberg test performed to assess Mr. M's balance is positive. (See Understanding the Romberg test. ) The ED physician suspects that Mr.[nursingcenter.com]
  • The first symptom was treatment-resistant neck pain.[bmccancer.biomedcentral.com]
Diplopia
  • Cranial-nerve involvement: Impaired vision, diplopia, hearing loss, and sensory deficits, including vertigo; cranial-nerve palsies commonly involve CN III, IV, VI, VII, and VIII Spinal-root involvement: Nuchal rigidity and neck and back pain, or invasion[operativeneurosurgery.com]
  • Clinical Presentation A 45-year-old woman presents with headache, nuchal rigidity, diplopia, and weakness in the left leg.[neupsykey.com]
  • He complained of diplopia on looking to the right. Prior to this, he had been in good health and had been able to work well. He had no known comorbidities.[jcytol.org]
  • Cranial-nerve involvement presents with impaired vision, diplopia (most common), hearing loss, and sensory deficits, including vertigo. Palsies of cranial nerves III, V, and VI are most common; palsy of nerve VII is less common.[aboutcancer.com]
  • Cranial nerve palsies resulting in diplopia, facial paralysis can also occur. These non-specific symptoms may be the initial signs in patients without tumor history [ 6 ].[bmcneurol.biomedcentral.com]
Facial Numbness
  • The symptoms of LC are related to the specific brain structures affected by the tumor: Cerebral involvement -- headaches, nausea, seizures, encephalopathy Cranial nerve involvement -- double vision, hearing loss, facial numbness, decreased vision Spinal[medpagetoday.com]
  • numbness/paresis * hearing impairment or loss * sensory deficits * vertigo * vision impairment or loss Spinal cord * back pain * bladder and bowel dysfunction * lower motor weakness * neck pain * paresthesias * radiculopathy * reflex asymmetry * sensory[nursingcenter.com]
  • Other cranial nerve symptoms include hearing loss, facial numbness, facial weakness, visual loss, dysphagia and hoarse voice.[cancerforum.org.au]
  • More than one half of patients with leptomeningeal metastases have cranial nerve palsies. 22 – 24 Common symptoms include diplopia, visual loss, dysphagia, hearing loss and facial numbness.[aafp.org]
Headache
  • The two patients in this study all presented progressive headache from the early stage to the end and the opening pressure of the first patient increasing from 200 to 350 mmH 2 O was consistent with her headache.[bmcneurol.biomedcentral.com]
  • The frequency of the paroxysmal headaches was decreased from every 2 h to every 4 h after the treatment. Hence, continued intrathecal therapy (h-R3, 25 mg) was given at the 3 rd day. One week later, the patient had slight headache occasionally.[cancerjournal.net]
  • […] worse early morning; He did not have a past history of headaches.[jcytol.org]
  • The MRI of brain showed no abnormal findings; however, the patient complained of an intractable persistent headache, nausea and vomiting on admission day 6.[kjim.org]
  • Headaches related to edema or increased intracranial pressure can sometimes be treated with steroids.[neupsykey.com]
Seizure
  • Symptoms including confusion, seizures, pain and paralysis may be a result of either metastases to the nervous system or one of several nonmetastatic complications of cancer.[books.google.com]
  • Supportive care for patients includes analgesia with opioids, anticonvulsants for seizures, antidepressants, and anxiolytics. Attention problems and somnolence from whole-brain radiation can be treated with psychostimulants or modafinil.[operativeneurosurgery.com]
  • Seizures are managed with anti-epileptic drugs (AEDS), but prophylactic administration of AEDs is not recommended in patients who have never had seizures.[neupsykey.com]
  • Individuals with this disorder are often prescribed analgesics with opioids, anticonvulsants for seizures, antidepressants, and anxiolytics.[secure.ssa.gov]
  • The first symptoms of the disease often include seizures, blurry vision and severe headaches, along with “a belt-like sensation” across the midsection, says Dr. Rudnick.[people.com]
Papilledema
  • FIG URE 2: Fundus photograph of the left optic disc showing marked papilledema. A similar appearance was noted in the right eye. FIGURE 3: Invasion of spinal cord nerve roots by tumor, iffematoxylin-easin X40).[healio.com]
  • […] associated with nausea, vomiting, light-headedness) Gait difficulties from weakness or ataxia Memory problems Incontinence Sensory abnormalities CNS symptoms are divided into the following 3 anatomic groups: Cerebral involvement: Headache, lethargy, papilledema[operativeneurosurgery.com]
  • . : A case of carninomatous meningitis with papilledema as the only symptom: favorable response to intrathecal chemotherapy . Ital. J. Neurol. Sci. 1:95–97, 1983. Google Scholar [17] Levinsky W.J. : Hypoglycorrhachia in diffuse meningeal neoplasm .[link.springer.com]
  • Physical: Involvement of CNS is divided into the following 3 broad anatomical groups: Cerebral involvement results in headache, lethargy, papilledema, behavior changes, and gait disturbance (the latter can be due to either cerebellar or cauda equina involvement[aboutcancer.com]
Confusion
  • And "my lung cancer doctor says, 'Valerie, we don't even use remission.' " Call it confusion over medical jargon. Call it sensationalizing. Call it miscommunication.[cnn.com]
  • Symptoms including confusion, seizures, pain and paralysis may be a result of either metastases to the nervous system or one of several nonmetastatic complications of cancer.[books.google.com]
  • Meningeal irritation, characterized by headache, fever, stiff neck (sometimes), confusion, and disorientation, sometimes develops several hours following intrathecal MTX administration but is self-limiting and resolves within 24-72 hours; no specific[aboutcancer.com]
  • The clinical presentations associated with MC are symptoms mainly due to increased intracranial pressure such as headache, nausea and vomiting, neck pain as well as confusion.[bmcneurol.biomedcentral.com]
  • (Left) Contrast-enhanced CT scan shows three separate tumor nodules (arrows) in a 42-year-old woman with breast cancer who developed headaches and confusion.[aafp.org]
Neck Stiffness
  • A 60-year-old, nonsmoking woman developed cephalgia and neck stiffness. She had a 14-month history of stage IV lung adenocarcinoma harboring an activating mutation of the EGFR due to the deletion of five amino-acids on exon 19.[academic.oup.com]
  • There was no neck stiffness or nystagmus. The sensory examination was normal. The conjunctivae were pale, but not icteric. The breathing sounds were clear and the heart sounds were regular without a murmur. Hepatosplenomegaly was not noted.[kjim.org]
  • The two patients had clinical symptoms before intrathecal treatment, such as headache, vomiting, vision disorder, neck stiffness, weakness of both lower extremities, and so on.[cancerjournal.net]
  • Meningeal irritation can lead to neck or back pain and neck stiffness. LM can produce virtually any neurological symptom and sign, and so must be considered in the differential diagnosis in patients with cancer and neurological symptoms.[cancerforum.org.au]
  • Pain is often prominent and can present as neck stiffness, localized spinal tenderness or radicular discomfort that radiates from the spine into an arm or leg ( Table 3 ) . 22 – 24 Weakness is also common and usually affects both legs in a lower motor[aafp.org]

Workup

  • […] cauda equina, or subependymal areas, which extend into the sulci of the cerebrum or folia of the cerebellum MRI of the spinal cord can show nerve-root thickening, cord enlargement, intraparenchymal and subarachnoid nodules, or epidural compression See Workup[emedicine.medscape.com]
  • Order a workup for LC in patients presenting with the following: Neurologic signs and symptoms at more than 1 level of the neuraxis (This is present in 75% of patients with LC.)[aboutcancer.com]
Alpha Fetoprotein Increased
  • Four percent (1/25) of the patients’ alpha-fetoprotein increased. The rate of elevated blood sedimentation was 66.7% (10/15). Imaging findings in MC patients Twenty-four cases had head computed tomography examinations.[nnjournal.net]
Pleural Effusion
  • Last, when computed tomography chest and abdomen was performed to see metastasis to other organs it showed mild irregular septal thickening suggestive lymphangitis carcinomatosis with skeletal metastasis with left pleural effusion.[cjhr.org]

Treatment

  • In May 2012, after 16 cycles of therapy, her regimen was changed to three weekly IV trastuzumab plus IT trastuzumab (50 mg) treatments. The treatments were well tolerated without severe toxicity.[e-crt.org]
  • However, the patient still suffered from weakness of both lower extremities after 8 months treatment. Then, she was diagnosed with LMC after 9 months treatment.[cancerjournal.net]
  • For each case, clinical, biological and radiological features were collected by medical oncologists, together with treatment modalities, response to treatment and date of death or last follow-up.[academic.oup.com]
  • With treatment approaches and the field of neuro-oncology neuroimaging changing rapidly, this second edition of the Handbook of Neuro-Oncology Neuroimaging is so relevant to those in the field, providing a single-source, comprehensive, reference handbook[books.google.com]
  • Case report peer-reviewed Leptomeningeal Carcinomatosis in Recurrent Non-Small Cell Lung Cancer: A Case Report and Review of Current Treatment Modalities Figures etc.[cureus.com]

Prognosis

  • The low incidence of breast cancer in male population might be related with it poorer prognosis. Conclusion: Meningeal carcinomatosis has a poor prognosis.[actamedicaportuguesa.com]
  • Patients with breast cancer have a relatively better prognosis with median survival of 6 months from the time of diagnosis of meningeal carcinomatosis. Patients with leukemia and lymphoma have the best prognosis with meningeal carcinomatosis.[neupsykey.com]
  • Complications Hydrocephalus occurs in a significant proportion of patients, is associated with poor prognosis and reduced quality of life, and usually precludes the use of intrathecal therapy.[operativeneurosurgery.com]
  • We propose a prognostic score in order to define three distinct groups of prognosis. Conclusions: MC presents a poor prognosis, but 1-year survival rate was 25%.[academic.oup.com]
  • The presence of LMC from NSCLC usually indicates a prognosis of 3-month median survival. However, after our treatment, patients had prolonged OS. The OS of one patient was 12.5 months. Another patient lived over 3 years.[cancerjournal.net]

Etiology

  • The etiology is diverse and includes infectious, granulomatous and inflammatory disorders, collagen vascular disorders, carcinoma, lymphoma, meningioma en plaque, sarcoidosis, haemodialysis, mucopolysaccharidosis, intrathecal drug administration, and[medical-dictionary.thefreedictionary.com]
  • However, this CSF profile is also seen in various inflammatory and infectious etiologies.[hematologyandoncology.net]
  • From the history and examination, it was clear that there was raised intracranial pressure, the etiology was not certain.[jcytol.org]
  • Pagina 330 - Intestinal infections in patients with the acquired immunodeficiency syndrome (AIDS): etiology and response to therapy. ‎[books.google.it]
  • Numb chin syndrome in cancer patients: etiology, response to treatment, and prognostic significance. Neurology . 1992;42:1181–4. Copyright 1999 by the American Academy of Family Physicians. This content is owned by the AAFP.[aafp.org]

Epidemiology

  • Epidemiology LC occurs in approximately 5% of people with cancer and is usually terminal.[operativeneurosurgery.com]
  • Department of Epidemiology, Faculdade de Saúde Pública Universidade de São Paulo Sao Paulo Brazil 3. Instituto do Coração, Faculdade de Medicina Universidade de São Paulo Sao Paulo Brazil[link.springer.com]
  • […] or spinal cord that causes cranial-nerve palsies or radiculopathies Alterations in the metabolism of nervous tissue that cause seizures, encephalopathy, or focal deficits Occlusion of blood vessels as they cross the subarachnoid, leading to infarcts Epidemiology[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • The first classifies the wide variety of disorders that can cause neurologic symptoms the patient with cancer, discusses the pathophysiology of nervous system metastases, the pathophysiology and treatment of brain edema and the approach to supportive[books.google.com]
  • Several pathophysiological mechanisms have been discussed such as direct nerve infiltration, nerve ischemia induced by IAC vessel compression and labyrinth infiltration [ 6 von Campe G., Regli F., Confavreux C., Aimard G.[em-consulte.com]
  • Pagina 302 - Groszmann RJ, Atterbury CE: The pathophysiology of portal hypertension: a basis for classification. Semin Liver Dis 1982; 2:177. ‎ Riduci Informazioni bibliografiche[books.google.it]
  • Pathophysiology Metastatic seeding of the leptomeninges may be explained by the following 6 postulated mechanisms: (1) hematogenous spread to choroid plexus and then to leptomeninges, (2) primary hematogenous metastases through the leptomeningeal vessels[emedicine.medscape.com]

Prevention

  • The physician who promptly recognizes neurologic symptoms occurring in a patient with cancer and makes an early diagnosis may prevent the symptoms from becoming permanently disabling or sometimes lethal.[books.google.com]
  • Intrathecal chemotherapy treats subclinical leptomeningeal deposits and tumor cells floating in the CSF, preventing further seeding. Cytarabine (Ara-C), methotrexate (MTX), and thiotepa are 3 agents routinely administered.[operativeneurosurgery.com]
  • Following the placement of an intraventricular catheter, methotrexate may be administered as 2 mg per day for 5 consecutive days every other week for four treatment cycles 2 – 4 Prophylactic treatment in lymphoma and leukemia Prevention of CNS relapse[neupsykey.com]
  • Newman is a recipient of a Research to Prevent Blindness Lew R. Wasserman Merit Award. References 1. avlidis N. The diagnostic and therapeutic management of leptomeningeal carcinomatosis.[hematologyandoncology.net]

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