Neuro-ophthalmologic Complications of Neoplastic Leptomeningeal Disease

Abstract

Neoplastic leptomeningeal disease (NLD), which encompasses both primary and secondary leptomeningeal tumors, has a devastating impact on the life of cancer patients. The present diagnostic technical armamentarium is insufficient for early diagnosis of NLD. However, NLD may present with subtle neuro-ophthalmic features at a time of relatively small tumor burden, which gives the provider first encountering these patients the window of opportunity for early diagnosis and consequently improved life expectancy and quality of life of these patients. Therefore, familiarity with early, often subtle neuro-ophthalmic features is an essential tool for diagnosing these patients prior to the development of fixed deficits, which usually portend a dismal prognosis. Future evolving laboratory and neuroimaging technologies are expected to advance our understanding of underlying pathophysiology and early detection of NLD. This paper provides an up-to-date review and synthesis of the current literature with focus on neuro-ophthalmic features and their underlying pathophysiology.

Neoplastic leptomeningeal disease masquerading as central serous retinopathy. A case report

“…After headache, double vision is the second most frequent presenting symptom. Other common ocular complaints include painless loss of vision, which can either be acute or progressive over weeks, and papilloedema, which is often present (albeit not in this case) 3 . NLMD carries a very poor prognosis with median survival rate of 3 weeks if left untreated, and this slightly improves to few months with systemic and intrathecal chemotherapy (3–6 months survival rate) 4 .…”