P2-2-2 - Two Cases of Total Blindness and Hydrocephalus Caused by Carcinomatous Meningitis of Gastric Cancer

Abstract

Background: Patients of gastric cancer with meningeal carcinomatosis may suddenly get worse and urgent medical treatment may be needed. Two didactic cases are presented.Case: Case 1 was a 48 years old woman was admitted with headache, neck pain, nausea, transient unconsciousness and liver dysfunction. Thickened gastric wall, lower bile duct stenosis was demonstrated by CT. Magnetic resonance imaging of brain showed dilated cerebral ventricle. Type 4 gastric cancer was found out by upper gastrointestinal endoscopy. Lumbar spinal puncture showed elevated cerebrospinal fluid pressure and malignant cells. Hydrocephalus and visual impairment got worse rapidly and she died on the 3rd hospital day by central respiratory failure. Case 2 was a 46 years old woman. After the surgical treatment for the gastric cancer, six courses of the combination chemotherapy of S-1 plus cisplatinum were performed as adjuvant chemotherapy. The chemotherapy could not withhold the progression and metastases to ovary and lymph nodes developed. Meningeal carcinomatosis developed and induced total blindness and hydrocephalus. To improve the cerebrospinal fluid pressure and meningeal carcinomatosis, intrathecal chemotherapy was initiated using Ommaya reservoir. She survived two months and finally died of respiratory failure.Discussion: Since the hydrocephalus accompanied by gastric cancer with meningeal carcinomatosis usually progress rapidly, prompt ventricular drainage is useful and mandatory to overcome oncology emergency such as progressive hydrocephalus with total blindness and respiratory failure.