Leptomenigeal Metastasis, MC Onco 54

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Medical ConferenceLeptomeningeal metastasis: clinical

manifestation and diagnosis

Surat TanprawateDivision of NeurologyChiang Mai University

27 Jan 2011

Thursday, 27 January 2011


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Cancer and the

nervous s stem Primary nervous system tumor

Nervous system metastasis Paraneoplastic syndrome

Indirect neurological complication fromcancer

Complication from therapy



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Leptomeningeal

metastasis 5% of cancer patient have LM metastasis

The incidence varies with different tumor

types

8% of patient with solid tumor

5-29% of patient with non-Hodgkinslymphoma

11-70% of leukemia patients



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Kesari, S. Neurol Clin N Am21 (2003) 2566



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Leptomeninges=arachnoid+pia mater

Anatomy of Leptomeninges



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Pathogenesis

Direct extensionbrain parenchymaepidural space

Hematogenous

spreading

CSF flow

Spread along thesurface of the

brain, spinal cord,

and nerve root



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Neurologicaldysfunction

Direct compression of brain structure bymeningeal nodule (focal symptoms)

Irritate adjacent brain (seizure)

Blocking of CSF pathways (leading tohydrocephalus and raised

intracranial pressure)

Ischemia, or stroke (by constriction of pialarteries)

Cranial and peripheral nerve palsies (bydirect nerve involvement)

Metabolic derangements (by decreasingavailable glucose for brain by rapidly

growing tumor cells)

Meningeal fibrosis



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Signs and symptoms of leptomeningeal metastasis

Cancer Invest2000;18:38194



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Case scenario

high index of suspicious

History of cancer Multiple neurological symptoms

Sign of meningeal irritation- present



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Neuro-imaging

Enhancement may be

linear or nodular

Kesari, S. Neurol Clin N Am21 (2003) 2566



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CSF finding

CSF findings increased protein (most cases) reduced glucose (25 to 30%)

lymphocytic pleocytosis (50%) elevated opening pressure(50%)



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Diagnostic test

Test Measurement Positive findings

Lumbar puncture

Lymphocytic pleocytosis

Elevate OP

Elevate protein

Reduced glucoseCytology after 1 LP

Cytology after 3 LP

Immunohistochemistry

PCR

>70%

50%

75%

30-40%50%

90%

Variable

Variable

Brain MRIMeningeal enhancementEnlarged ventricle

>50%


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Thank you

Th d 27 J 2011

Leptomenigeal Metastasis, MC Onco 54

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