Carcinomatous Meningitis Secondary to Transitional Cell Bladder Cancer

Abstract

We report a patient with carcinomatous meningitis secondary to known transitional cell carcinoma of the bladder. The patient presented with multiple focal neurological signs and symptoms. Diagnosis was suggested by magnetic resonance imaging and confirmed by analysis of the cerebrospinal fluid. He received whole brain radiotherapy despite a poor prognosis. To our knowledge, this is only the fifth reported case of neoplastic meningitis due to bladder cancer with confirmatory imaging and cytology and only the fourth reported case that presented with cranial nerve involvement.

Clinical Reasoning: An 81-year-old woman with confusion, weakness, and left-sided hemineglect

“…In carcinomatous meningitis secondary to transitional cell carcinoma, the most common presenting symptoms reported are diffuse headache and mental status changes. 7 In a review of 22 reported cases, five had cranial nerve involvement, and all but one of these cases had cranial nerve VII involvement. 7 There have been no reports of carcinomatous meningitisassociated sensory hemineglect that we are aware of, but sensory disturbance is not uncommon.…”

“…7 In a review of 22 reported cases, five had cranial nerve involvement, and all but one of these cases had cranial nerve VII involvement. 7 There have been no reports of carcinomatous meningitisassociated sensory hemineglect that we are aware of, but sensory disturbance is not uncommon. The MRI and CSF examination of our patient was markedly abnormal, and this has been reported in a few cases of transitional cell carcinoma associated carcinomatous meningitis.…”

“…9 While the median survival of untreated patients with carcinomatous meningitis is one month, treatment with the aforementioned modalities improves the median survival to approximately three months. 7 However, prognosis may vary based on the underlying cancer.…”

Urothelial Carcinoma with Intracranial Lesion: Metastasis or Abscess?

“…Neoadjuvant chemotherapy with cisplatin and gemcitabine was followed by radical cystectomy. Pathology case reports [7][8][9][10][11]. Our case represents a first case, to the best of our knowledge, of a patient presenting with both parenchymal intracranial as well meningeal metastasis in a patient with a history of urothelial carcinoma previously treated with surgery and adjuvant therapy, in the absence of any additional extracranial systemic metastasis.…”

Clinical features of patients with carcinomatous meningitis in the chinese population: report of 4 cases and review of literature

“…CM has been described in isolated case reports (2,3,13). Clinical course and neuroimaging findings have not been investigated in detail in the Chinese population.…”