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Meningeal Carcinomatosis

Brain Tumor Meningeal Carcinomatosis


Presentation

  • We report a case of meningeal carcinomatosis presenting as a complete, bilateral, sudden hearing loss without other cranial nerve findings--a previously unreported presentation.[ncbi.nlm.nih.gov]
Difficulty Walking
  • For example, if the patient has difficulty walking, a hiking pole, cane, walker, or wheelchair may be indicated.[nursingcenter.com]
  • She has been very dizzy, nauseated, vomitting and has difficulty walking. We will be meeting with new doctors April 20, 2005 to discuss Intrathecreal Chemotherapy. Can anyone share their stories of how this treatment worked for them.....[cancercompass.com]
Anorexia
  • Abstract 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]
Pseudotumor
  • CT scan was normal, consistent with the diagnosis of pseudotumor cerebri. At craniotomy for placement of a ventriculoperitoneal shunt, the dura was found to be infiltrated with adenocarcinoma.[ncbi.nlm.nih.gov]
Nausea
  • We reported a clinical case of a woman with esophagus adenocarcinoma that a few months after surgical operation, presented episodes of vomiting, nausea, hypertension, mental change, unconsiousness; A contrast-enhanced CT of the brain revealed an "area[ncbi.nlm.nih.gov]
  • Most patients were admitted to hospital with increased intracranial pressure symptoms such as headache, nausea and vomit.[nnjournal.net]
  • […] sites (at MC diagnosis) Bone 61 (67) Liver 38 (42) Brain 35 (38) Lymph nodes 27 (30) Lung 26 (29) Pleura 12 (13) Skin 16 (18) Spine 9 (10) Neurologic symptoms (at MC diagnosis) Headache 34 (37) Cranial nerves symptoms 25 (27) Cerebellar signs 24 (26) Nausea–vomiting[academic.oup.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]
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]
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]
  • 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]
  • In early March 2014 she developed headache and neck pain.[pancreas.imedpub.com]
  • The first symptom was treatment-resistant neck pain.[bmccancer.biomedcentral.com]
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]
  • Her left-sided facial numbness and hearing loss markedly improved as well. Discussion Decisions regarding optimal cancer treatment modalities for leptomeningeal carcinomatosis depend on the patient, presentation, risk status, and cancer type.[cureus.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]
  • 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]
Meningism
  • Tuberculous or fungal meningitis was initially suspected; however, cytological evidence of adenocarcinoma in the CSF led to the diagnosis of meningeal carcinomatosis.[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]
Seizure
  • 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]
  • 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]
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]
  • We discuss how to proceed before a bilateral papilledema due to intracranial hypertension.[pesquisa.bvsalud.org]
  • 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]
Confusion
  • 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]
  • 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]
  • Chemical meningitis secondary to intrathecal treatment can occur in 20%-40% of cases, and presents with headache, mental confusion, delirium and acute pain radiating into the extremities 47-49.[scielo.br]

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.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]
Hyponatremia
  • A 59-year-old man was admitted to our hospital because of disturbance of consciousness and hyponatremia. The patient had suffered from acute myelogenous leukemia (AML) with 46,XY and received chemotherapy for 5 years.[ncbi.nlm.nih.gov]

Treatment

  • However, development of new treatments is lacking and a standard treatment guideline is not yet available.[ncbi.nlm.nih.gov]

Prognosis

  • 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]
  • 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]

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]

Epidemiology

  • This study analyses the epidemiology, the prognostic factors, the diagnostic tools, currently available treatments and the possible future therapies of meningeal carcinomatosis in breast cancer. [Indexed for MEDLINE] Free full text[ncbi.nlm.nih.gov]
  • 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]
  • J Clin Oncol 2004; 22:2865–72 2 Gavrilovic IT, Posner JB, Brain metastases: epidemiology and pathophysiology. J Neurooncol 2005; 75:5–14 3 Narita Y, Shibui S, Strategy of surgery and radiation therapy for brain metastases.[medmedia.at]
  • […] 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.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]
  • The combination of headache, rapidly progressive visual loss, sluggish pupil reactions, and normal optic discs should bring to mind the diagnosis of meningeal carcinomatosis. 3 The pathophysiologic mechanisms of visual loss include migration of tumour[nature.com]
  • Several pathophysiological mechanisms have been discussed such as direct nerve infiltration, nerve ischemia induced by IAC vessel compression and labyrinth infiltration [ 6 ].[em-consulte.com]
  • J Clin Oncol 2004; 22:2865–72 2 Gavrilovic IT, Posner JB, Brain metastases: epidemiology and pathophysiology. J Neurooncol 2005; 75:5–14 3 Narita Y, Shibui S, Strategy of surgery and radiation therapy for brain metastases.[medmedia.at]
  • Pagina 302 - Groszmann RJ, Atterbury CE: The pathophysiology of portal hypertension: a basis for classification. Semin Liver Dis 1982; 2:177. ‎[books.google.it]

Prevention

  • At this time, he began to take 4 mg of oral zoledronic acid once a month to prevent bone metastases. The result of a cytology exam of the cerebrospinal fluid showed that the man had meningeal carcinomatosis.[ncbi.nlm.nih.gov]
  • New chapters in this edition focus on the hospitalist's increasing role in providing critical care, managing surgical patients with medical co-morbidities, ensuring patient safety and preventing adverse events, and directing hospital systems areas such[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]

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