Keeping an open mind about meningitis: a case report of carcinomatous meningitis

摘要

Carcinomatous meningitis is defined as leptomeningealinfiltration by malignant cells. A case of carcinomatousmeningitis, originally diagnosed as viral meningitis, ispresented here to highlight the importance of maintaininga broad differential diagnosis in patients with evidence ofmeningeal irritation. Clinical and laboratory clues thatsuggest a diagnosis of carcinomatous meningitis in a patientwith meningeal irritation include the presence and type ofunderlying malignancy (more common with breast cancer,lung cancer, and melanoma), absence of fever, presence ofradicular pain, evidence of both cranial and spinal involvement, consistent cerebrospinal fluid (CSF) findings(increased opening pressure, elevated protein concentration,decreased glucose, increased white cell count), and supportive neuroimaging. Diagnosis is based on positive CSFcytology results, which may require multiple lumbar puncture procedures to obtain. For patients with a known primarymalignancy who present to the emergency department withsymptoms and/or signs of meningeal irritation, carcinomatous meningitis should be included in the differentialdiagnosis.