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      Carcinomatous meningitis: Yet another cause for rapidly progressive dementia and triphasic waves in electroencephalograph!

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          Abstract

          We report a 65-year-old woman who manifested with progressive cognitive impairment, abnormal behavior, slurred speech, inability to carry out activities with right upper limb, gait disturbances, emotional liability, and double incontinence that evolved progressively over the last 8 months. A clinical syndrome of “rapidly progressive dementia” was considered. The MRI of brain was unremarkable except for small para third ventricular enhancing lesion was detected in the left thalamic region. There was bi/tri-phasic sharp waves in the routine scalp EEG occurring at periodically 1.5–2.0 Hz, mimicking Creutzfeldt–Jakob disease (CJD). She was later diagnosed to have carcinomatous meningitis based on cerebrospinal fluid (CSF) cytology. This case is being discussed for rarity and interesting EEG observations in patients with carcinomatous meningitis and to highlight the importance of CSF cytology in an appropriate clinical setting. One needs to be careful in concluding CJD as possible diagnosis in such scenario.

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          Leptomeningeal carcinomatosis. Presenting features and prognostic factors.

          M Balm, J Hammack (1996)
          To determine factors that are predictive of survival among patients with leptomeningeal carcinomatosis. Studies of potential prognostic factors in leptomeningeal carcinomatosis have produced conflicting results. Reasons for the discrepancies may be methodological differences in case ascertainment, treatment protocols, and limitations due to the size of the study group. We reviewed the medical records of 126 patients with cytologically confirmed leptomeningeal carcinomatosis seen at the Mayo Clinic in Rochester, Minn, from 1983 to 1994. Clinical, radiographic, and cerebrospinal fluid (CSF) parameters at the time of presentation are summarized. Treatment response, complications, and cause of death are also discussed. Using the forward stepwise Cox model, independent predictors of survival were identified. Independent negative predictors of survival include elevated CSF protein (P < .001) and clinical involvement of the cerebral leptomeninges (P = .05). Independent positive predictors of survival were longer duration of neurological symptoms at the time of presentation (P < .005), treatment with intrathecal or intraventricular (intra-CSF) chemotherapy (P = .01), and female sex (P = .02). Other variables, including age, primary tumor type, and extent of systemic disease, were not predictive. We conclude that female sex, longer duration of neurological symptoms, absence of cerebral leptomeningeal clinical involvement, and absence of elevated CSF protein independently predict better survival. Patients treated with intra-CSF chemotherapy also survived longer.
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            The pulvinar sign on magnetic resonance imaging in variant Creutzfeldt-Jakob disease.

            R Sellar, D. Hadley, D. Collie … (2000)
            There is a need for an accurate non-invasive diagnostic test for variant Creutzfeldt-Jakob disease (vCJD). We investigated the sensitivity and specificity of bilateral pulvinar high signal on magnetic resonance imaging (MRI) for the diagnosis of vCJD. MRI from patients with vCJD and controls (patients with suspected CJD) were analysed. Scans were reviewed on two separate occasions by two neuroradiologists and scored for the distribution of changes, and likely final diagnosis. Scans from vCJD cases were reassessed to reach a consensus on all abnormalities. We analysed 36 patients and 57 controls. vCJD patients were correctly identified based on bilateral pulvinar high signal in 29 of 36 and 32 of 36 cases on the first assessment by the two radiologists, and 32 of 36 and 31 of 36 on their second assessment. Bilateral increased pulvinar signal was identified in one of 57 and one of 57 controls on the first assessment and two of 57 and three of 57 controls on the second assessment. These reported changes in controls were graded as minimal/equivocal in six of seven patients and moderate in one (<0.5% of all control assessments). 80% of the assessments in vCJD cases were graded as moderate or substantial. On consensus review, 28 of 36 cases and none of 57 controls had prominent bilateral pulvinar signal-sensitivity 78% (95% CI 60-90%) and specificity 100% (95% CI 94-100%). Other common MRI features of vCJD were medial thalamic and periaqueductal grey matter high signal, and the notable absence of cerebral atrophy. Pulvinar high signal correlated with histological gliosis. In the appropriate clinical context the MRI identification of bilaterally increased pulvinar signal is a useful non-invasive test for the diagnosis of vCJD.
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              Cytologically proven meningeal carcinomatosis in patients with lung cancer: clinical observation of 34 cases.

              Tzu-Yi Chuang, Chong-Jen Yu, Jin-Yuan Shih … (2008)
              Meningeal carcinomatosis (MC) is a rare neurologic complication of lung cancer. Occasionally, it is the initial presentation of lung cancer. The clinical features of MC exclusively in lung cancer patients have not been well identified and characterized. The purpose of this report is to disclose the clinical features, laboratory findings, treatment and survival of patients with MC from lung cancer. We reviewed the medical records of 34 lung cancer patients with cytologically diagnosed MC at National Taiwan University Hospital from 1992 to 2002. Clinical symptoms and signs, cerebrospinal fluid parameters and lung cancer staging at the time of presentation were summarized. Previous treatment modalities for lung cancer, various treatments and response of MC, complications and survival times were also analyzed. Cerebrospinal fluid cytology revealed adenocarcinoma in 32 patients, and small cell carcinoma and squamous cell carcinoma in one each. MC occurred in approximately 0.7% of lung cancer patients. Nine patients had MC as the initial presentation of lung cancer. Symptom improvement was found in six patients who had whole brain irradiation for MC and one patient who had a ventriculoperitoneal shunt. Two of the patients with whole brain irradiation survived for longer than 1 year. Survival from cytologic diagnosis of MC ranged from 1 day to 82 weeks (median, 5.1 weeks). There was no difference in survival between patients treated by whole brain irradiation and other treatment modalities. The prognosis of MC from lung cancer is poor. A prospective study is needed to establish the effectiveness of combined modality therapy for patients with MC from lung cancer.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Neurosci Rural Pract
                Journal ID (iso-abbrev): J Neurosci Rural Pract
                Journal ID (publisher-id): JNRP
                Title: Journal of Neurosciences in Rural Practice
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0976-3147
                ISSN (Electronic): 0976-3155
                Publication date (Print): May-Aug 2012
                Volume: 3
                Issue: 2
                Pages: 207-209
                Affiliations
                [1] Department of Neurology, NIMHANS, Bangalore, India
                [1 ] Department of Neuromicrobiology, NIMHANS, Bangalore, India
                [2 ] Department of Neuropathology, NIMHANS, Bangalore, India
                [3 ] Department of Neuroimaging and Interventional Neuroradiology, NIMHANS, Bangalore, India
                Author notes
                Address for correspondence: Dr. Sanjib Sinha, Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore - 560 029, Karnataka, India. E-mail: sanjib_sinha2004@ 123456yahoo.co.in
                Article
                Publisher ID: JNRP-3-207
                DOI: 10.4103/0976-3147.98253
                PMC ID: 3410003
                PubMed ID: 22865984
                SO-VID: 662e7836-93a5-4365-8e7d-2325cd79ea9d
                Copyright © Copyright: © Journal of Neurosciences in Rural Practice
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Neurosciences
                Keywords: triphasic waves,dementia,carcinomatous meningitis
                Data availability:
                ScienceOpen disciplines: Neurosciences
                Keywords: triphasic waves, dementia, carcinomatous meningitis

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