Malignant Meningitis Associated with Hydrocephalus

Abstract

Malignant meningitis (MM) is the diffuse involvement of the leptomeninges by infiltrating cancer cells, most frequently from lung and breast cancers. This review is aimed to discuss the current advances in the diagnosis and management of MM, along with management of MM-associated hydrocephalus. We reviewed the literature using PubMed and Google Scholar search engines, focusing on various recent randomized controlled trials and clinical trials on MM. Given the hallmark multifocal involvement, the clinical symptoms and signs are also random and asymmetric. There are three important pillars for establishing a diagnosis of MM: clinical examination, neuroimaging, and CSF cytological findings. Several factors should be considered in decision-making, including performance status, neurological findings (clinical, MRI, and CSF flow dynamic), and evaluation of the primary tumor (nature and systemic dissemination). Response Assessment in Neuro-Oncology (RANO) working group recommended the objective assessment of disease for evaluating the progression and response to therapy. Pillars of current management are mainly focal irradiation and intrathecal or systemic chemotherapy. Symptomatic hydrocephalus is managed with a ventriculoperitoneal shunt, lumboperitoneal shunt, or endoscopic third ventriculostomy as palliative procedures, providing significant improvement in performance scores in the limited survival time of patients with MM. Studies using novel therapeutic approaches, such as new biological or cytotoxic compounds, are ongoing. Despite the use of all the combinations, the overall prognosis remains grim; therefore, decision-making for treatment should predominantly be based on attaining an optimal quality of life.

Basic Analysis of the Cerebrospinal Fluid: An Important Framework for Laboratory Diagnostics of the Impairment of the Central Nervous System

“…Some authors described hyperproteinorhachia, pleiocytosis with lymphocyte predominance, and hypoglycorrhachia in the CSF of patients with malignant infiltration of meninges [ 51 , 53 , 59 , 60 , 61 ]. Our results are consistent with these findings.…”

“…There are also numerous non-infectious causes of inflammatory response in CSF, such as autoimmunity, injury, hemorrhage, ischemia, tumors and neurodegenerative disorders [ 4 , 6 , 9 , 10 , 50 , 51 , 52 , 53 , 54 , 55 ].…”

“…Deep analysis of inflammatory parameters can identify the presence of malignancy in CNS even if tumor cells in the CSF cytology are absent. Elevated proteins, pleiocytosis with predominance of lymphocytes and hypoglycorrhachia are characteristic in CSF patients with malignant infiltration of meninges [ 51 , 53 , 59 , 60 , 61 ].…”