Clinical Presentation, Diagnosis, and Radiological Findings of Neoplastic Meningitis

Georgios Rigakos, MD; Chrysoula I. Liakou, MD; Naillid Felipe, Dennis Orkoulas-Razis, MHS; Evangelia Razis, MD, PhD

Cancer Control. 2017;24(1):9-21.

Conclusions

In many cases, neoplastic meningitis presents with various neurological symptoms that are not always attributable to a single area of the central nervous system. Although the disease must be differentiated from paraneoplastic and infectious syndromes, the diagnosis is not difficult to identify in a patient with advanced malignancy. However, a definitive diagnosis is more elusive, because both radiology and cytology findings of the cerebrospinal fluid may not yield adequate proof of neoplastic meningitis. Persistence on the part of the clinician is required so that the diagnosis can be established and therapy can be initiated. The complexity of establishing the diagnosis cannot be understated, as multiple false-negative results on cytology and imaging may not necessarily exclude neoplastic meningitis. Thus, the diagnosis may depend on clinical judgment and experience.^[6] To help aid in the diagnosis, newer techniques are being investigated to facilitate the diagnostic process.

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Acknowledgment
We thank Theodoros Poufos for his help in the editing and formatting of this article.

No significant relationships exist between the authors and the companies/organizations whose products or services may be referenced in this article.

Table 1. Frequent, Infrequent, and Rare Symptoms of Neoplastic Meningitis
	Frequent	Infrequent	Rare
Cerebral symptoms	Communicating hydrocephalus⁶ Gait alterations Headache Nausea Seizure^6,13 Vertigo Vomiting	Altered mental status¹⁶ Nuchal rigidityl³	Isolated mental change⁶ Noncommunicating hydrocephalus³ Photophobia Seizure
Cranial nerve dysfunction	Diplopia Dysphagia Facial hypoesthesia^3,6 Hearing loss⁶ Hoarseness Hypoacusia Ocular motility deficits⁹ Vision loss ^3,6,9	—	Bilateral tinnitus¹³ Numb chin syndrome Vestibulocochlear nerve involvement³
Spinal symptoms	Bilateral/unilateral pain³ Loss of reflexes^3,8,14 Paresis Motor deficits Weakness in extremities^3,6	Incontinence^3,8,14,15 Intestinal dysfunction^3,8,14	Chest pain¹⁷
Other	—	—	Asymptomatic^10,12 Neoplastic meningitis presenting before primary cancer^3,9,18

Table 2. Findings on Examination of the Cerebrospinal Fluid
Laboratory Study	Value^a
Pressure	> 150 mm H₂O
White blood count	> 4 cells/mm3 Solid tumors: Most frequently neutrophils, mononuclear cells, or both Lymphomas: Mostly lymphocytes
Protein	> 50 mg/dL
Glucose	< 40 mg/dL
Cytology	Positive
Flow cytometry	Hematological malignancies Monoclonal λ or κ light chain B-cell lineage Chromosomal abnormalities Solid tumors not useful