Neoplastic meningitis resulting from hematological malignancies. Leptomeningeal metastases society for neurooncology. A condition due to cancer that has spread from the original primary tumor to the meninges, the tissue covering the brain and spinal cord. Bacterial meningitis is a rare but potentially fatal disease. The diagnosis of neoplastic meningitis is based on clinical signs and symptoms, laboratory. Notwithstanding frequent focal signs and symptoms, nm is a disease affecting the entire neuraxis, and therefore staging and treatment need encompass all cerebrospinal fluid csf compartments. A 68yearold man visited our ed with a 3month history of headache. Soda pdf merge tool allows you to combine pdf files in seconds. Clinicoradiological features, outcome and prognostic factors article pdf available in neurology asia 151. Neoplastic meningitis is a result of the spread of malignant cells to the. Symptoms will vary based on the location of lesions. Neoplastic meningitis presenting with ophthalmoplegia.
Whitley7 1drexel university college of medicine, philadelphia, pennsylvania. Neoplastic meningitis is diagnosed based on three factors. Here, flow cytometry which allows for an assessment of specific cell surface markers, e. Neoplastic meningitis refers to infiltration of the meninges by tumor cells. Neoplastic meningitis treatments are considered palliative, with an emphasis on limiting symptoms such as neurologic deterioration and extending quality of life. It is most often recognized in patients with leukemia, breast cancer, lymphomas, and smallcell cancer of the lung, although it may be seen with virtually any malignancy. The uveomeningeal syndromes are a group of disorders that share involvement of the uvea, retina, and meninges. Some children with meningitis may have longterm problems, but this depends on the cause of the infection and the age of the child. Guidelines for the management of acute meningitis in. Neoplastic meningitis is the development of meningitis due to infiltration of the subarachnoid space by tumor cells. There are vaccines, which can be used to help prevent this kind of meningitis. Neoplastic meningitis is the initial manifestation of systemic cancer in only 510% of patients.
Aseptic meningitis is caused by viruses, mycobacteria, spirochetes, fungi, medications, and cancer malignancies. Neoplastic meningitis beate gleissner, marc charles chamberlain neoplastic meningitis is a complication of the cns that occurs in 35% of patients with cancer and is characterised by multifocal neurological signs and symptoms. Less often, the dura, leptomeninges, skull base, or cranial nerves may be affected. Nspc is at the forefront of advanced brain cancer treatments and participates in clinical trials to help in the search for cures to these lifechanging. Meningitis occurs in people of all ages, but it is more common in children and people over 65. Neoplastic meningitis knowledge for medical students and. Meningitis caused by these bacteria is called meningococcal. Practice guidelines for the management of bacterial meningitis. Diagnosis, initial management, and prevention of meningitis. Meningitis is an acute inflammation o the pertective membranes coverin the harn and spinal cord, kent collectively as the meninges.
The terms neoplastic meningitis and carcinomatous meningitis refer to the dissemination of cancer. I have received the information regarding meningococcal meningitis disease and vaccine, including information regarding the availability and cost of the meningococcal meningitis vaccine. Based on the origin of the primary tumor, the condition may be categorized as carcinomatous, lymphomatous, or leukemic meningitis. Although csf cytology and mri are standard methods to diagnose neoplastic meningitis nm, this complication of neoplastic disease remains difficult to detect. Neoplastic meningitis nm results from the spread of malignant cells to the leptomeninges and subarachnoid space and their dissemination within the cerebrospinal fluid csf compartment. Guidelines for the management of acute meningitis in children and adults in south africa this guideline provides a rational and costeffective approach to patients with acute meningitis, which causes considerable morbidity and mortality, predominantly in children. Three cases of neoplastic meningitis initially diagnosed. Because of its good tolerance profile, combining ivent. Symptoms are often multifocal, involving cerebral, spinal, and cranial nerve components of the neuroaxis see table. Chamberlain, in handbook of brain tumor chemotherapy, 2006.
Jeanpierre barral, alain croibier, in manual therapy for the cranial nerves, 2009. Subacute meningitis and chronic meningitis usually progress slowly and gradually, but doctors may have difficulty determining what the cause is and thus what the treatment should be. The frequency of neoplastic meningitis is increasing because of heightened clinical suspicion, improved neuroimaging techniques, and longer survival in patients with extraneural cancer longer survival. Neoplastic meningitis nm is a common problem in neurooncology occurring in approximately 12 per cent of all the patients with primary brain tumors. Meningitis is an inflammation of the covering of the brain and spinal cordalso called the meninges. Neoplastic meningitis is more likely to occur in patients with disseminated cancer, but in, respectively, 20% and 10% of cases it may manifest after a diseasefree. Provincial case definitions for diseases of public health significance disease. We report 3 patients with nm, who were misdiagnosed with infectious meningitis in emergency department ed. Smoking, secondhand smoke and crowded living conditions also increase the risk for some kinds of. Haemophilus influenzae type b bacteria, called hib, can also cause meningitis. Nm is not infrequent, and is becoming more common as cancer patients live longer. Neoplastic meningitis presenting before primary cancer3,9,18.
Because of its good tolerance profile, combining iv ent. Some clinical features are secondary to elevated intracranial pressure and include headaches, papilledema, and altered mental. Neoplastic meningitis nm is the result of seeding of the leptomeninges by malignant cells and is becoming more common as cancer patients live longer. Diffuse leptomeningeal infiltration by neoplastic cells is a wellrecognized manifestation of malignant tumors. Central nervous system cns staging of nm includes contrastenhanced. Combine or merge files into a single pdf, adobe acrobat dc. The pia mater is the innermost layer of the meninges and is directly adherent. Neoplastic meningitis nm is a common problem in neurooncology, occurring in approximately 5% of all patients with cancer. Medical management of viral meningitis consists of supportive treatment and there is.
Practice guidelines for bacterial meningitis cid 2004. Neoplastic meningitis appears to be increasing in frequency with improvements in the treatment of many cancers. Treatment of nm aims to improve neurological symptoms and extend overall survival os, especially when the disease is diagnosed early on. Treatment options include drug delivery directly into the cns or systemic. Useful tests to establish diagnosis and guide treatment include. Use the combine files tool to merge word, excel, powerpoint, audio, or video files, web pages, or existing. With mri and csf study, he was diagnosed with tuberculous meningitis. Pdf neoplastic meningitis nm is a devastating complication of solid tumors with poor outcome. In general, meningitis due to bacteria bacterial meningitis is more severe than meningitis caused by viruses viral meningitis. Brain metastases and neoplastic meningitis clinical gate. Meningitis powerpoint 2009 warren hills regional school. Neoplastic meningitis nm is diagnosed by the presence of malignant cells in the cerebrospinal fluid csf. Nm is a disease affecting the entire neuraxis and, therefore, clinical manifestations are pleomorphic affecting the spine, cranial nerves, and cerebral hemispheres.
People with suspected meningitis will usually need to have tests in hospital and may need to stay in hospital for treatment. Neoplastic meningitis, also known as leptomeningeal metastases, is a complication of. Diagnosis is problematic because the disease is commonly the result. Notwithstanding frequent focal signs and symptoms, nm is a disease that affects the entire neuraxis. Neoplastic meningitis refers to the spread of malignant cells through the cerebrospinal fluid space. Bamberger, md, university of missourikansas city school of medicine, kansas city, missouri a cute meningitis is a medical emer. Neoplastic meningitis neurological surgery long island ny. Pdf leptomeningeal metastasis lm results from metastatic spread of cancer to the leptomeninges. The organized approach to the patient with suspected meningitis enables the prompt administration of.
It consists of the spread of malignant cells to the leptomeninges and subarachnoid space and their. Several tests may be carried out to confirm the diagnosis and check whether the condition is the result of a viral or bacterial infection. However, treatment can result in significant palliation of the cns and is best approached by a multidisciplinary team. I havemy child has for students under the age of 18 received the meningococcal meningitis immunization menomune within. Neoplastic meningitis is recognized clinically in 4% to 7% of patients with extraneural cancer, but it remains dramatically underdiagnosed. The disease can also occur when certain bacteria invade the meninges directly. Acute bacterial meningitis is particularly serious and worsens rapidly. A serious problem that may occur in cancer in which cancer cells spread from the original primary tumor to the meninges thin layers of tissue that cover and. This chapter discusses the epidemiology, pathogenesis, clinical features, diagnosis, prognosis, and treatment of neoplastic meningitis. Additionally, people with weak immune systems are more at risk for meningitis. The term is a misnomer because the condition is not inflammatory. Viral aseptic meningitis is a serious, but not usually fatal with people with healthy immune systems.
Most cases of acute meningitis are infectious and result from a potentially wide range of bacterial and viral pathogens. The outer and inner cyst walls merge at the cyst mar. Leptomeningeal cancer also called leptomeningeal carcinomatosis, leptomeningeal disease lmd, leptomeningeal metastasis, neoplastic meningitis, meningeal metastasis and meningeal carcinomatosis is a rare complication of cancer in which the disease spreads from the original tumor site to the meninges surrounding the brain and spinal cord, this leads to an inflammatory response, hence the. Viral oncolytic therapeutics for neoplastic meningitis dtic. Diagnosis is problematic because the disease is commonly the result of pleomorphic manifestations of neoplastic meningitis and cooccurrence of disease at other sites. Neoplastic meningitis is an increasingly recognized complication of advanced metastatic cancer and, if left undiagnosed or untreated, is characterized by rapid neurologic deterioration and death. Neoplastic meningitis was first reported in the 1870s. Neoplastic meningitis nm is the result of seeding of the leptomeninges by malignant cells. Leptomeningeal cancer also called leptomeningeal carcinomatosis, leptomeningeal disease lmd, leptomeningeal metastasis, neoplastic meningitis, meningeal metastasis and meningeal carcinomatosis is a rare complication of cancer in which the disease spreads from the original tumor site to the meninges surrounding the brain and spinal cord, this leads to an inflammatory response, hence the alternative names neoplastic meningitis nm, malignant meningitis, or carcinomatous meningitis. Most children with viral meningitis recover completely.
Diagnosis, initial management, and prevention of meningitis david m. The testing for both meningitis and aseptic meningitis is mostly the same. Aseptic meningitis is the inflammation of the meninges, a membrane covering the brain and spinal cord in patients whose cerebral spinal fluid test result is negative with routine bacterial cultures. Neoplastic meningitis is a late, difficulttotreat com plication found in 5% of all patients with cancer. Introduction to meningitis brain, spinal cord, and nerve. A recurrent challenge in the diagnosis of neoplastic meningitis which is suspected by clinical or imaging findings is negative csf cytology despite advanced histological workup. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. It affects approximately 5% of all patients with cancer. Pdf merge combine pdf files free tool to merge pdf online. Plasma cell meningitis is an uncommon neurologic complication of multiple myeloma with a very poor prognosis median overall survival of 3 months.
We therefore reevaluated the sensitivity of gadolinium gdenhanced mri and cerebrospinalfluid csfcytology and the relevance of tumor type and csf cell count. Neoplastic meningitis is a complication of solid and hematological malignancies. Neoplastic meningitis nm is a common problem in neuro. There are many aetiologies, but a small number of bacteria and viruses. Combining the most appropriate systemic chemotherapy for the primary. Nm is a frequent complication of systemic cancer and occurs in 4%15% of all patients with solid tumors. Pdf an nmr metabolomics approach for the diagnosis of. Clinical presentation, diagnosis, and radiological. Meningitis is generally an infection involving the inflammation of the meninges which is becoming an increasingly common noninfectious disease. Most people with viral or noninfectious meningitis recover within a few weeks. Neoplastic meningitis is a complication of the cns that occurs in 35% of patients with cancer and is characterised by multifocal neurological signs and symptoms. Some people may not be able to have treatment for their cancer because they are too unwell.
Several types of bacteria can first cause an upper respiratory tract infection and then travel through the bloodstream to the brain. Thus, the diagnosis and treatment of neoplastic meningitis present challenges for the clinical oncologist. Treatment of nm aims to extend survival and stabilize or improve neurological symptoms. Definition of neoplastic meningitis nci dictionary of cancer terms. Epidemiology central nervous system metastases are common, affecting as many as 25% of patients with cancer. The usual clinical presentation is subacute or chronic meningitis with multifocal cranial and spinal nerve root symptoms and a variable degree of. It can be caused by viruses, parasites, fungi, and bacteria.
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