Intractable Headache in a Patient with Carcinoma Breast: Infiltrative or Infective - A Diagnostic Challenge (original) (raw)
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Different Presentation of Treatment in Carcinomatous Meningitis of Breast Cancer: Report of 3 Cases
Background: Carcinomatous Meningitis (CM) refers to the multifocal seeding of the leptomeninges by malignant cells. CM occurs in approximately 5% of patients with breast cancer. Herein, we suggest that Intrathecal (IT) can use in treatment of breast cancer patients with CM before of any treatment until can prevent of going patient to debilitating phase of this disease. Patients and Methods: Three patients with high risk breast cancer with CM: A 62 year-old Kurdish woman with a history of lung tuberculosis. Her cerebrospinal fluid was positive for malignant cells. She treated with IT chemotherapy and died 3 months after diagnosis of CM. A 48 year-old woman in premenopausal states had a left axillary mass for last 4 months. After one year of followed up she complaints with refractory headache. In cerebrospinal fluid (CSF) analysis with diagnosis of CM treated with brain irradiation and multiple courses of IT chemotherapy. After six months she is well still and in follow up with previo...
An unusual presentation of carcinomatous meningitis
Oxford medical case reports, 2016
A 67-year old previously well male presented with a 1 week history of confusion on a background of 3 weeks of headache. Past history included two superficial melanomas excised 5 years ago. Treatment for meningoencephalitis was commenced based on lumbar puncture (LP) and non-contrast brain magnetic resonance imaging (MRI) results. Lack of a clinical response to antibiotics resulted in a second LP and contrast brain MRI which demonstrated hydrocephalus and leptomeningeal disease. Ongoing deterioration led to a whole-body computed tomographic and spinal MRI that showed widespread metastatic disease and extensive leptomeningeal involvement of the spinal cord. The diagnosis of metastatic melanoma with carcinomatous meningitis was made based on cytological analysis of cerebrospinal fluid. He died 2 weeks later in a palliative care facility. This case illustrates that the diagnosis of carcinomatous meningitis can be difficult to make as the heterogeneous nature of its presentation often de...
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Cancer control : journal of the Moffitt Cancer Center, 2017
Neoplastic meningitis is a complication of solid and hematological malignancies. It consists of the spread of malignant cells to the leptomeninges and subarachnoid space and their dissemination within the cerebrospinal fluid. A literature review was conducted to summarize the clinical presentation, differential diagnosis, laboratory values, and imaging findings of neoplastic meningitis. Neoplastic meningitis is an event in the course of cancer with a variable clinical presentation and a wide differential diagnosis. In general, characteristic findings on gadolinium-enhanced magnetic resonance imaging and the presence of malignant cells in the cerebrospinal fluid remain the cornerstones of diagnosis. However, both modalities do not always confirm the diagnosis of neoplastic meningitis despite a typical clinical picture. Clinicians treating patients with cancer should be aware of the possibility of neoplastic meningitis, especially when multilevel neurological symptoms are present. Neo...
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Carcinomatous meningitis (CM) is an uncommon but devastating complication of malignancy. The management is controversial and clear recommendations cannot be made because: 1) Most series include patients with CM that has arisen from different primary malignancies which are associated with different median survival intervals. 2) There have been no prospective randomised investigations of treatment modalities in patients with CM from a particular tumour type.
Neoplastic meningitis from systemic malignancies: diagnosis, prognosis and treatment
Seminars in oncology, 2006
Long-term survival is occasionally observed in patients with neoplastic meningitis (NM) accompanying breast cancer (13% one-year and 6% 2-year survival), melanoma, and lymphoma, but in general the survival of most patients is short and averages only 3 to 4 months. The incidence of NM appears to be increasing, in part due to earlier detection by magnetic resonance imaging (MRI), and in part due to development of more effective therapies for systemic cancer, which has resulted in a larger subset at risk for late-stage development of this complication. Survival of NM patients is negatively affected by concomitant progression of systemic disease despite multiple prior therapies. However, there are certain prognostic factors that have been identified as "favorable" in retrospective series, including age less than 60 years, long symptom duration, controlled systemic disease, Karnofsky performance status (KPS) > or =70, lack of encephalopathy or cranial nerve deficits, low ini...
Chronic and Subacute Meningitis: Differentiating Neoplastic From Non-Neoplastic Etiologies
The Neurohospitalist, 2018
Background and Purpose: Although incidence rates vary, infectious, autoimmune, and neoplastic diseases can all cause chronic and subacute meningitis (CSM). We report a Latin-American, single center, CSM case series, analyzing the main clinical characteristics as well as ancillary diagnostic methods differentiating neoplastic from non-neoplastic etiologies. Methods: Retrospective review of CSM cases from a single center in Buenos Aires, Argentina. Results: Seventy patients with CSM diagnosis were identified, 49 with neoplastic and 21 with non-neoplastic meningitis. A history of previous cancer was significantly higher in neoplastic cases, whereas prevalence of autoimmune disease and fever was more common in non-neoplastic meningitis. C-reactive protein values were higher in non-neoplastic CSM, as was pleocytosis in cerebrospinal fluid analysis. The most frequent etiologies were breast and lung cancer for neoplastic meningitis cases; and idiopathic, tuberculous, and fungal infection f...
Leptomeningeal Carcinomatosis Originated from Breast Cancer
Journal of Microbiology and Infectious Diseases, 2015
Malignant melanoma, breast cancer and lung cancer are the most causative malignancies of leptomeningeal carsinomatosis (LC). A LC case that was previously diagnosed as tuberculosis meningitis, is presented here to emphasize the importance of maintaining a broad differential diagnosis in patients applied to the hospital with meningeal irritation symptoms. A 35-year-old woman was suffering from a severe headache and photophobia. Physical examination revealed nuchal rigidity but Kernig's and Brudzinski signs were negative. Cerebrospinal fluid (CSF) findings were 171 cells/mm3 (lymphocytic predominance), elevated protein levels, decreased glucose. Atypical cells were detected in CSF cytology. The result of breast biopsy was in accordance with breast lobular carcinoma nuclear grade III. LC, usually developes in patients who have a known primary malignancy. As it occured in our case; in up to 10%-20% of cases, however, symptoms caused by LC may emerge before the diagnosis of the primary tumor. It should remember that meningitis may not be always infectious originated.