Carcinomatous Meningitis

Posted by e-Medical PPT Friday, January 6, 2012
Aseptic Meningitis
Clinical and laboratory evidence for meningeal inflammation with negative bacterial cultures
Common causes include viruses, fungal meningitis, parameningeal infections, medications, malignancy

Differential Diagnosis
Viral etiologies- enterovirus, primary HIV infection, HSV, mumps
Other infections- spirochetes, tick-borne diseases, fungal infections, tuberculous infections, bacterial
Drug induced meningitis

Important Physical Exam Findings
Nuchal Rigidity- Brudzinski and Kernig sign
Altered mental status
Focal neurologic deficits, papilledema
Rash, arthritis
Jolt accentuation of headache

Carcinomatous Meningitis
Clinically diagnosed LM in 5% of patients with metastatic cancer
Most common involved cancers: breast cancer, lung cancer, melanoma, GI malignancy
Most common presentation is pain: radicular discomfort, headache, neck/back pain

Diagnosis
If high suspicion: obtain enhanced MRI of symptomatic region of brain or spine prior to lumbar puncture
Typical MRI findings: thin, diffuse leptomeningeal contrast enhancement- can sometimes see mutiple nodular deposits. 
Typical CSF: high opening pressure, low glucose, high protein, lymphocytic pleocytosis, and positive cytology
Repeat LP if suspicion is high but cytology negative!

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