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Meningeal Carcinomatosis

Brain Tumor Meningeal Carcinomatosis


Presentation

  • We present a case of gastric cancer with meningeal signs present when the primary tumors were diagnosed. Radiotherapy alleviated some of the symptoms, and the patient survived for as long as patients undergoing enforced chemotherapy.[ncbi.nlm.nih.gov]
  • 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]
  • Meningeal carcinomatosis (MC) is a rare presentation of solid tumors, particularly breast cancer, lung cancer, and malignant melanoma. Recently, the incidence of MC has been reported to be increasing.[ncbi.nlm.nih.gov]
  • The patient presented with headache, fever, and meningeal irritation with a subacute course.[ncbi.nlm.nih.gov]
  • Our observation is a cue to analyze the accuracy in the diagnosis of meningeal carcinomatosis, and presents a choice that may facilitate early diagnosis.[ncbi.nlm.nih.gov]
Hunting
  • Ramsay Hunt syndrome was suspected, but no increase in the cerebrospinal fluid cell count was detected. On the other hand, the balance test suggested a central disorder.[ncbi.nlm.nih.gov]
Sudden Hearing Loss
  • Sudden hearing loss due to meningeal carcinomatosis from rectal carcinoma. Auris Nasus Larynx. 2006;33: 315-319. 21. oyle P, Ferlay J. Cancer incidence and mortality in Europe, 2004.[hematologyandoncology.net]
  • However, a patient presenting with a history of cancer and sudden hearing loss is suggestive of LC involving the inner ear and a high-resolution MRI exploration should be carried out. Conflicts of interest None.[em-consulte.com]
Progressive Sensorineural Deafness
  • We report the case of a 59-year-old man with meningeal carcinomatosis (MC) who presented with peripheral facial palsy and progressive sensorineural deafness.[ncbi.nlm.nih.gov]
Splinter Hemorrhage
  • Funduscopy showed a bilateral papilledema, juxtapapillary exudates and splinter hemorrhages. Brain MRI showed a diffuse leptomeningeal enhancement in cortical sulcus.[ncbi.nlm.nih.gov]
  • The optic discs were swollen to greater than six diopters with splinter hemorrhages, venous tortuousity and peripapillary retinal edema. Hemorrhages were apparent to the midequatorial zone, clinically resembling central retinal venous obstruction.[healio.com]
Neck Pain
  • Three months later, he was readmitted for evaluation of headaches, neck pain and numbness of the left arm.[healio.com]
  • In early March 2014 she developed headache and neck pain.[pancreas.imedpub.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]
  • 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
  • Eye symptoms may be the chief complaint, so MC should be considered in any patient with vision loss or diplopia accompanied by neurologic symptoms and in the absence of an intraocular cause, especially in the context of systemic cancer.[ncbi.nlm.nih.gov]
  • We describe a patient who had metastatic carcinoma of the stomach and severe headaches, weakness, and diplopia.[ncbi.nlm.nih.gov]
  • The disease affects all levels of the central nervous system, with the most common symptoms of the disease being headache, change in mental status, diplopia, hearing loss, facial numbness, and vision loss.[ncbi.nlm.nih.gov]
  • He later developed unsteadiness and head-movement-dependent oscillopsia due to vestibular areflexia and diplopia. At that time MRI showed leptomeningeal enhancement.[ncbi.nlm.nih.gov]
  • A 53-year-old male presenting with anorexia, intermittent diplopia, general fatigue, headache and vertigo was admitted to our hospital. He was diagnosed as having gastric cancer by endoscopy of his upper gastrointestinal tract.[ncbi.nlm.nih.gov]
Facial Numbness
  • The disease affects all levels of the central nervous system, with the most common symptoms of the disease being headache, change in mental status, diplopia, hearing loss, facial numbness, and vision loss.[ncbi.nlm.nih.gov]
  • 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]
  • Other cranial nerve symptoms include hearing loss, facial numbness, facial weakness, visual loss, dysphagia and hoarse voice.[cancerforum.org.au]
  • 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]
  • 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]
Overflow Incontinence
  • Moreover, a striking clinical improvement with resolution of the paraparesis of the legs and overflow incontinence was observed.[ncbi.nlm.nih.gov]
Headache
  • The MRI of brain showed no abnormal findings; however, the patient complained of an intractable persistent headache, nausea and vomiting on admission day 6.[ncbi.nlm.nih.gov]
  • We report four case studies where back pain, dizziness, cognitive decline, headache and headache with the cranial nerve VI palsy were the first signs of MC.[ncbi.nlm.nih.gov]
  • 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]
  • We describe a patient who had metastatic carcinoma of the stomach and severe headaches, weakness, and diplopia.[ncbi.nlm.nih.gov]
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]
  • We report a 66-year-old man, smoker, who presented with two episodes of secondarily generalized partial motor seizures.[ncbi.nlm.nih.gov]
  • The presenting manifestations are usually headache, visual disturbances and seizures. We report a case of leptomeningeal metastasis that presented as a gastric cancer.[ncbi.nlm.nih.gov]
  • Both patients presented with progressive headache and seizures. Gadopentetate dimeglumine-enhanced magnetic resonance imaging of the brain was performed and did not detect any abnormality of meninges.[ncbi.nlm.nih.gov]
  • Symptoms at presentation were headache, cranial nerve dysfunction, seizures, and intracranial hypertension signals. Diagnosis was made by CSF cytology in 66.7% of cases and by MRI in 71.7%.[ncbi.nlm.nih.gov]
Papilledema
  • Funduscopy showed a bilateral papilledema, juxtapapillary exudates and splinter hemorrhages. Brain MRI showed a diffuse leptomeningeal enhancement in cortical sulcus.[ncbi.nlm.nih.gov]
  • 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]
  • A 36-year-old woman presented with headache, multiple cranial nerve palsies, visual hallucinations, confusion, hemiparesis, hemihipoestesia, episodes of disconnection, and toxic syndrome.[ncbi.nlm.nih.gov]
  • 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 most common symptoms include an altered mental state, which means confusion, and a pressure headache that is worst in the morning and that gets progressively more intense over several days and weeks.[mdanderson.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

  • In two others, it was discovered at workup (lung, ethmoid adenocarcinoma). In the last case, no primary cancer was identified. Vestibular symptoms were the first complaint in five of the six cases.[ncbi.nlm.nih.gov]
  • […] 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]

Treatment

  • However, development of new treatments is lacking and a standard treatment guideline is not yet available.[ncbi.nlm.nih.gov]
  • The median overall survival was short but some patients clearly benefited from this treatment, even used as second line.[ncbi.nlm.nih.gov]
  • Prospective studies are necessary to clarify the role of IT and systemic treatment in the treatment of those patients.[ncbi.nlm.nih.gov]
  • Previous treatment modalities for lung cancer, various treatments and response of MC, complications and survival times were also analyzed.[ncbi.nlm.nih.gov]
  • A lumbo-peritoneal shunt might be considered for meningeal carcinomatosis refractory to gefitinib treatment without an emergence of a T790M mutation.[ncbi.nlm.nih.gov]

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]
  • Early treatment can improve prognosis. Presence of brain metastasis, ECOG PS and IC were correlated with prognosis of patients, whereas IC is an independent prognostic factor.[ncbi.nlm.nih.gov]
  • We propose a prognostic score in order to define three distinct groups of prognosis. MC presents a poor prognosis, but 1-year survival rate was 25%. This score may become a useful tool for treatment decision and clinical trials.[ncbi.nlm.nih.gov]
  • In recent decades there has been an apparent increase in the number of EOC patients diagnosed with brain metastases, probably as a result of improved prognosis of patients with advanced tumors, but cases of meningeal carcinomatosis complicating EOC remain[ncbi.nlm.nih.gov]
  • It has a bad prognosis despite aggressive therapy. The usual clinical presentation is multifocal involvement of the neuraxis, with headache and radicular pain being the most common initial symptoms.[ncbi.nlm.nih.gov]

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]
  • 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]
  • 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]
  • 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]
  • Pagina 302 - Lee GC-Y, et al: Prevention of perinatally transmitted hepatitis B virus infection with hepatitis B immune globulin and/or HB vaccine, in Vyas GN, Dienstag JL, Hoofnagle JH (eds): Viral Hepatitis and Liver Disease. ‎[books.google.it]

References

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