P16.09.B NEUROGENIC DYSPHAGIA IN MENINGEOSIS NEOPLASTICA PATIENTS

Abstract

Abstract BACKGROUND Meningeosis neoplastica (MN) occurs in 5-10 % of all cancers and is characterized by diffuse seeding of tumor cells in the cerebrospinal fluid (CSF) and meninges. Common clinical symptoms suggestive of MN include headache, cranial nerve (CN) deficits, psychiatric symptoms as well as paresthesia. Neurogenic dysphagia (ND) has been suggested a rare MN symptom resulting from affection of CN IX and X. The aim of this work was to investigate frequency, severity and pattern of malfunction of ND due to MN as well as to assess its impact on the rate of pneumonia and overall survival. MATERIAL AND METHODS The database of the Institute of Neurooncology of the University Hospital Frankfurt was screened for patients with MN diagnosed between March 2009 and July 2021 who received a systematic dysphagia assessment (DA). DA comprised a standardized clinical swallowing examination as well as an additional fiber optic endoscopic evaluation of the swallowing act (FEES) in case of suspected aspiration. Severity of dysphagia and extent of oral impairment were systematically recorded. In addition to demographics, clinical diagnoses, underlying cancer and treatment, information on radiological imaging including presence of contrast-enhancing lesions was collected. RESULTS A total of 262 patients with a diagnosis of MN were detected, 69 of whom (52 % women, mean age 61 ± 14 years) were included for further analysis. Underlying cancers included lung cancer (16 cases, 23 %), breast cancer (15, 22 %), as well as lymphoma and melanoma (each 7 cases, 10%). The remaining 24 patients suffered from cancer entities (ovarian cancer, gastrointestinal tumors or cancers of unknown primary). 46 patients (66.6 %) were diagnosed with ND, 15 of these patients required a feeding tube (FOIS 1-3). Dysphagic patients had an increased risk of pneumonia (p<0.001) and a shorter survival time compared to non-dysphagic patients (p=0.003). Affection of the cranial nerves affected CN V (n=6), CN VII (n=22), CN IX (n=21), CN X (n=7) and CN XII (n=12). There was no significant correlation between the presence of an ND and the above-mentioned cranial nerve deficits. CONCLUSION The results of this study show that ND is a common symptom in patients with MN and can also occur independently of paresis of CN IX and X. In addition, the presence of ND is associated with a higher rate of pneumonia and a shorter survival time. Therefore, patients with suspected or confirmed MN should receive a systematic dysphagia assessment. In addition, the presence of MN should also be considered in the differential diagnosis of unclear neurogenic dysphagia.