Confusion and altered behaviour? Cause

Abstract

We describe the case of a 65-year-old man who presented with confusion and change in behaviour, and describe the investigative steps that were taken before a diagnosis was made. This patient was eventually diagnosed with leptomeningeal carcinomatosis secondary to a previously undiagnosed oesophageal carcinoma.

Isolated leptomeningeal carcinomatosis and possible fungal meningitis as late sequelae of oesophageal adenocarcinoma

“…Neurological complications resulting from leptomeningeal carcinomatosis secondary to a primary oesophageal cancer have previously been described,4 5 7 but this is the first report of a recurrence presenting in this fashion. A possible mechanism for the development of leptomeningeal metastases without nodal disease could be dural injury and seeding at the time of resection; however, the description of previous similar cases, particularly that described by Lobo et al , which presented with leptomeningeal seeding without any surgical intervention,7 raises the possibility that this could be a natural, rather than iatrogenic, phenomenon. Of note, in the case described by Lobo et al , lesser curvature, coeliac, and para-aortic lymphadenopathy was noted on CT scanning; in our case, no lymphadenopathy was found.…”

“…Neurological sequelae of oesophageal carcinoma are rare and may be due to cerebral or leptomeningeal metastases and paraneoplastic phenomena. Previous case reports illustrate the primary presentation of oesophageal carcinoma as classic meningitis,4 malignant meningitis causing sensorineural hearing loss,5 limbic encephalitis6 and confusion 7. Recurrence following treatment has also been described presenting with haemorrhagic brain metastasis 8.…”

“…Neoplastic meningitis is suggested by clinical presentation consistent with meningitis or encephalitis, in conjunction with cerebrospinal fluid (CSF) showing a high lymphocyte count, high protein and low glucose level, and negative microbiological investigations 7…”

Breast leptomeningeal metastasis recurrence presenting as a manic episode

“…An autopsy revealed a tumor in the fundus of the gall bladder with meningeal carcinomatosis in the absence of a metastatic tumor in the substance of the brain, spinal cord, or choroid plexus. Nevertheless, the delirium picture was classical and included visual hallucinations, deteriorating short-term memory, paranoid delusions, and agitation (Lobo et al, 2013). Meningeal carcinomatosis secondary to prostate cancer presenting as delirium tremens has also been reported (Rubins & Guzman-Paz, 1997).…”