Disease Information for Meningeal carcinomatosis

Tumor cells that have spread from the original (primary) tumor to the tissue that covers the brain, spinal cord, or both -----------------------------------------------------The neoplasms metastasizing most commonly to the leptomeninges are carcinoma of the breast, lymphomas, and leukemia; Leptomeningeal metastases lead to multifocal neurologic deficits, which may be associated with infiltration of cranial and spinal nerve roots, direct invasion of the brain or spinal cord, obstructive hydrocephalus, or some combination of these factors; The diagnosis is confirmed by examination of the cerebrospinal fluid; Findings may include elevated cerebrospinal fluid pressure, pleocytosis, increased protein concentration, and decreased glucose concentration; Cytologic studies may indicate that malignant cells are present; if not, spinal tap should be repeated at least twice to obtain further samples for analysis; CT scans showing contrast enhancement in the basal cisterns or showing hydrocephalus without any evidence of a mass lesion support the diagnosis; Gadolinium-enhanced MRI frequently shows enhancing foci in the leptomeninges; Myelography may show deposits on multiple nerve roots; Treatment is by irradiation to symptomatic areas, combined with intrathecal methotrexate; The long-term prognosis is poor—only about 10% of patients survive for 1 year—and palliative care is therefore important (End of Life Care)-----[CMDT 2005]-----------

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