Leptomeningeal metastasis (LM) usually occurs in patients with previous cancer. But rarely it can be the first mnifestation of cancer. We analyzed primary tumors and early clinical findings in 12 patients in whom LM was the presenting sign of
cancer.
Primary tumors were lung cancer in 5 cases, stomach cancer 1, lymphoma 1 and unknown 5.
Most patients, previously healthy, developed progressive headache which was followed by symptoms and signs involving multiple neuraxis. Major symptoms on admission were headche, nausea, vomiting, visual dimness, diplopia, hearing destrubance and
the
major neurologic deficits were papilledema, ocular motor palsy, facial palsy, decreased DTR and neck stiffness.
Fromthese clinical findings and CSF test, initially LM was suspected in only 6 patients. In the remaining 6 patients, initial diagnoses were tuberculous meningitis (3), benign intracrnial hypertension (2) and adjustment disorder (1). In addtition
to
cytology, which was positive in 9 cases. CSF carcinoembryonic antigen (CEA) and neuroimaging played an important role in the early diagnosis of LM.
Despite whole brain radiation therapy, all patients worsened and expired 2 weeks 10 weeks (median survival, 3 weeks) after the diagnosis.
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