Carcinomatous meningitis refers to metastasis in the region of the meninges.
Epidemiology
Carcinomatous meningitis occurs in approximately 5% of all patients with tumors and in up to 20% of patients in autopsy studies1. The prevalence is higher in solid tumors than in hematologic neoplasms.
Symptoms
Carcinomatous meningitis typically manifests with cauda equina syndrome, communicating hydrocephalus, or cranial nerve deficits2.
Differential Diagnoses
In cases of increased contrast enhancement of the meninges, the following differential diagnoses should be evaluated3:
- Neurogenic: Intracranial hypotension or increased CSF pressure.
- Inflammatory: Sarcoidosis
- Infectious: Subacute and chronic meningitis: tuberculosis, fungal infection, or granulomatous cellular infiltration.
- Vascular: Local ischemia, venous thrombosis, hypoxia, subarachnoid hemorrhage
- Traumatic
- Medication-induced: Chemotherapeutic agents, heavy metals
- Neoplastic: Locally infiltrating tumor, primary meningeal glioma, primitive neuroectodermal tumor (PNET), isolated primary meningeal melanoma, rhabdomyosarcoma of the leptomeninges.
- Other: Metabolic disorders, response to hyperventilation, ionizing radiation
References
Le Rhun, Emilie, Sophie Taillibert, and Marc C. Chamberlain. "Carcinomatous meningitis: leptomeningeal metastases in solid tumors." Surgical neurology international 4.Suppl 4 (2013): S265. ↩ ↩
Chamberlain, Marc, et al. "Leptomeningeal metastasis: a Response Assessment in Neuro-Oncology critical review of endpoints and response criteria of published randomized clinical trials." Neuro-oncology 16.9 (2014): 1176-1185. ↩ ↩
Neurosurgery Case Review: Questions and Answers. Remi Nader, Abdulrahman J Sabbagh. 2020 Thieme Verlage. ISBN 9781626231986 ↩ ↩