Ver el código de «Neoplastic meningitis»

==Background==
*Also known as Leptomeningeal Carcinomatosis or leptomeningeal metastasis (LM)
*Uncommon and late complication of solid tumors and hematological cancers, approximately 5-8% and 5-15% respectively
*Most common primary tumors associated with LM are breast, lung, and melanoma
*Commonly misdiagnosed due to symptoms mimicking infectious [[meningitis]] and chronic [[headache]]

===Pathophysiology===
*Multiple routes tumor cells can gain access to CSF
*Most commonly thought to be through hematogenous spread via arachnoid vessels or direct extension from brain parenchyma 

==Clinical Features==
*Chronic [[headache]]
*[[Nausea and vomiting]]
*[[Fever]]
*Nuchal rigidity
*[[Altered mental status]]
*[[Seizure]]
*[[Spinal cord compression (non-traumatic)]]
**Limb weakness
**Dermatomal sensory loss
**Radicular pain
**Bladder and bowel dysfunction
*[[Cranial nerve abnormalities]]
**[[Diplopia]]
**Facial weakness
**Hearing loss
**[[Ataxia]]

==Differential Diagnosis==
{{Headache DDX}}

==Evaluation==
[[File:Meningeosis carcinomatosa bei Mamma-Ca - fokal - MRT T1 KM axial.jpg|thumb|Meningeal carcinomatosis on contrast-enhanced axial T1-weighted MRI.]]
===Workup===
*CT brain is not sensitive or specific, may show intracranial mass
*MRI brain and spine with contrast preferred (70% sensitivity, 77-100% specificity)
**Leptomeningeal enhancement
**[[Hydrocephalus]]
**Subependymal nodules or deposits
*[[Lumbar Puncture]]-mainly to rule out infectious etiology in ED
**Elevated opening pressure
**Glucose, protein, cell count and cytology can be abnormal
**Malignant cells on CSF smear 

===Diagnosis===
*Leptomeningeal enhancement or lesions on MRI
*Malignant cells on CSF smear

==Management==
*Control seizures
**[[Benzodiazepines]]
**[[Antiepileptics]]
**Intubation if [[status epilepticus]]
*Pain management if headache, radicular pain
*Steroids may be indicated depending on severity of symptoms

==Disposition==
*Admit

==See Also==


==External Links==


==References==
<references/>
*Shin Ahn, Kyung Soo Lim, "Three Cases of Neoplastic Meningitis Initially Diagnosed with Infectious Meningitis in Emergency Department", Case Reports in Emergency Medicine, vol. 2013, Article ID 561475, 4 pages, 2013.
*Batool A, Kasi A. Leptomeningeal Carcinomatosis. [Updated 2020 Apr 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499862/
*Cooney DR, Cooney NL. Meningeal carcinomatosis diagnosed during stroke evaluation in the emergency department. Int J Emerg Med. 2011;4:52. Published 2011 Aug 9. doi:10.1186/1865-1380-4-52

[[Category:Neurology]]