neurologic disorders
Subacute and Chronic Meningitis
Carcinomatous meningitis
In patients with cancer, tumor cells may spread to the meninges. Spread most commonly occurs in patients with lung or breast cancer and melanoma but can occur in many other cancers. Carcinomatous meningitis is usually a late complication of cancer and should be considered if any patient with cancer has a change in mental status, hydrocephalus, or clinical signs referable to cranial or spinal nerve roots. Similar leptomeningeal involvement can also occur in patients with leukemias or lymphomas, including primary CNS lymphoma. CSF changes may be nonspecific (pleocytosis, low glucose, elevated protein); detection of malignant cells may require multiple lumbar punctures. MRI with gadolinium is used to detect metastatic deposits on nerve roots or other structures. Treatment is directed against the underlying tumor, but prognosis is poor; the cancer usually recurs within 6 months. 