Meningeal carcinomatosis diagnosed during stroke evaluation in the emergency department

Derek R Cooney,Norma L Cooney

doi:10.1186/1865-1380-4-52

Derek R Cooney, Norma L Cooney

Open Access

https://doi.org/10.1186/1865-1380-4-52

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Abstract

A 70-year-old female presented to the emergency department with a 3-day history of intermittent dysphasia and right facial droop. Computed tomography (CT) and magnetic resonance imaging (MRI) were obtained, and the patient was found to have meningeal carcinomatosis, also known as leptomeningeal metastases. Meningeal carcinomatosis is a rare metastatic complication of some solid tumors and hematopoietic neoplasms, and has a median survival rate of 2.4 months. The role of the emergency physician is to appropriately diagnose this condition, treat emergent side effects, provide symptomatic relief, and ensure multi-disciplinary management.

Highlights

Meningeal carcinomatosis (MC), known as leptomeningeal metastases, is a rare metastatic complication of some solid tumors and hematopoietic neoplasms [1]
Case presentation A 70-year-old female presented to the emergency department with a 3-day history of intermittent dysphasia and right facial droop
magnetic resonance imaging (MRI) of the brain confirmed the diagnosis of meningeal carcinomatosis, and the edema finding provided some evidence of a brain tumor as the primary neoplasm

Summary

Background

Meningeal carcinomatosis (MC), known as leptomeningeal metastases, is a rare metastatic complication of some solid tumors and hematopoietic neoplasms [1]. Incidence in patients with a primary solid tumor is 4-15% [2]. The approach to the patient with altered mental status includes a broad differential diagnosis including infectious, neurologic, and toxicologic causes. In this case, the presentation and history direct the physician to a neurologic etiology. MRI of the brain confirmed the diagnosis of meningeal carcinomatosis, and the edema finding provided some evidence of a brain tumor as the primary neoplasm. Dexamethasone has been shown to decrease intracranial pressure and cerebral edema in cases of brain tumors [4]. Stabilization and symptomatic care are the immediate goals in the ED, and the patient improved with anti-epileptic drugs (AEDs), steroids, and narcotics prior to admission

Findings

Discussion

Conclusion