Carcinomatous Meningitis from Unknown Primary Carcinoma

Abstract

Carcinomatous meningitis (CM) occurs in 3 to 8% of cancer patients. Patients present with a focal symptom, and multifocal signs are often found following neurological examination. The gold standard for diagnosis remains the demonstration of carcinomatous cells in the cerebrospinal fluid on cytopathological examination. Despite the poor prognosis, palliative treatment could improve quality of life and, in some cases, overall survival. We report on a patient who presented with vertigo, tinnitus and left-sided hearing loss followed by progressive diffuse facial nerve paralysis. Lumbar cerebrospinal fluid confirmed the diagnosis of CM. However, no primary tumor was discovered, even after multiple invasive investigations. This is the first reported case in the English-language medical literature of CM resulting from a carcinoma of unknown primary origin.

Peripheral facial palsy caused by neoplastic meningitis

“…A total of 22 cases, including the six cases from our series, were reviewed. The primary tumor site, initial symptoms, and brain MRI findings were summarized in Table . The most frequent accompanying symptom was hearing loss, followed by pain in the head and neck region.…”

“…The primary tumor site, ini-tial symptoms, and brain MRI findings were summarized in Table 1. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] The most frequent accompanying symptom was hearing loss, followed by pain in the head and neck region. Fourteen patients had hearing loss; and five patients complained of ear or head pain around the time of onset of facial palsy.…”

Leptomeningeal Carcinomatosis From Carcinoma of Unknown Primary in a Young Patient: A Case Report and a Literature Review

“…The prognosis of LM from known solid tumors is poor, ranging from 4 to 6 weeks without treatment 3 to 3 to 6 months with treatment. 4 The primary treatment goal is palliation to improve the neurological deficits as well as the quality of life.…”

An Unusual Presentation of Isolated Leptomeningeal Disease in Carcinoma of Unknown Primary With Pancreatic Features

“…Clinical manifestations of LMD can be vast and depend on degree of involvement of cerebral hemispheres, cranial and peripheral nerve roots, as well as spinal cord. 10 Common symptoms of LMD include headaches, mental status changes, nausea, vomiting, gait difficulty, weakness, seizures, and back pain. 1 , 2 , 6 Different cancer types have different mechanisms by which malignant cells enter the meninges.…”

“…Death usually results from neurological deficits, with median survival ranging between 4 and 6 weeks without treatment. 10 …”