Cerebral FDG-PET hypermetabolism in carcinomatous meningitis.

摘要

A 69-year-old man with a history of recent gastric adenocarcinoma presented with subacute visual disturbance, confusion, and weight loss. Fundoscopy was normal. Clinical examination showed optic ataxia, visual attention disturbance, and simultanagnosia consistent with Balint syndrome. MRI revealed a hyperintense posterior cortex, associated with meningeal gadolinium enhacement (fig. 1). EEG only showed frontal slowing. FDG-PET revealed hypermetabolism in the involved posterior regions. Blood and CSF paraneoplastic antibodies were absent. CSF showed lymphocytic pleocytosis (30 cells/m2), elevated protein, and positive cytology for adenocarcinoma. Carcinomatous meningitis was diagnosed. Since identifying CSF tumor cells is often difficult, FDG-PET might help in the diagnosis of carcinomatous meningitis [1, 2]. Other PET tracers, like uC-methi-onine (not used in our patient since this tracer was not available at our center), may also show increased uptake in carcinomatous meningitis [3].