Abstract
Neoplastic meningitis (NM) is diagnosed by the presence of malignant cells in the cerebrospinal fluid (CSF). We report 3 patients with NM, who were misdiagnosed with infectious meningitis in emergency department (ED). Case 1. A 68-year-old man visited our ED with a 3-month history of headache. With MRI and CSF study, he was diagnosed with tuberculous meningitis. After 20 days, repeated CSF cytology showed malignant cells. His diagnosis was lung cancer with NM. Case 2. A 57-year-old man visited regional hospital ED with a 3-week history of headache and diplopia. Brain MRI was not contributory. With CSF examination, his diagnosis was aseptic meningitis. With worsening headache, he was referred to our ED. Repeated CSF showed malignant cells. His diagnosis was stomach cancer with NM. Case 3. A 75-year-old man visited a regional hospital with headache lasting for 4 months. His diagnosis was sinusitis. Persistent symptom brought him back, and he developed recurrent generalized seizures. Brain MRI showed diffuse leptomeningeal enhancement suggesting meningitis, and he was transferred to our ED. CSF exam showed malignant cells. His diagnosis was NM with unknown primary focus. When evaluating the patients with headache in ED, NM should be kept in mind as a differential diagnosis of meningitis.
Highlights
Leptomeningeal carcinomatosis, so-called neoplastic meningitis (NM), is one of the complications of advanced cancer, occurring in 3–8% of all cancers with major neurological disability and high mortality [1]
We report 3 patients without previous history of malignancy, whose initial presentation was NM, but were misdiagnosed with meningitis of infectious origin in emergency department (ED) (Table 1)
Diagnosis of NM can be made by clinical findings, cerebrospinal fluid (CSF) cytology, and neuroimaging studies
Summary
Leptomeningeal carcinomatosis, so-called neoplastic meningitis (NM), is one of the complications of advanced cancer, occurring in 3–8% of all cancers with major neurological disability and high mortality [1]. Diagnosis of NM is made by clinical manifestations with appropriate findings on neuroimaging study or by examination of the cerebrospinal fluid (CSF) for the presence of malignant cells. The sensitivity of the initial CSF is approximately 50–60% and that of the enhanced magnetic resonance imaging (MRI) of brain is about 70% in diagnosing NM [2]. We report 3 patients without previous history of malignancy, whose initial presentation was NM, but were misdiagnosed with meningitis of infectious origin in emergency department (ED) (Table 1)
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