Neoplastic meningitis natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
Neoplastic meningitis has a widely disseminated and progressive presentation. If left untreated, neoplastic meningitis may progress to develop [[seizures]], [[hydrocephalus]], [[encephalopathy]], and ultimately death. | Neoplastic meningitis has a widely disseminated and progressive presentation. If left untreated, neoplastic meningitis may progress to develop [[seizures]], [[hydrocephalus]], [[encephalopathy]], and ultimately death. Complications of neoplastic meningitis include [[hydrocephalus]], [[encephalopathy]], [[empyema]], [[cerebritis]], [[cerebral abscess]], and [[stroke]]. The median survival time of patients without treatment of neoplastic meningitis is 4-6 weeks. | ||
==Natural History== | ==Natural History== | ||
*Neoplastic meningitis has a widely disseminated and progressive presentation. | *Neoplastic meningitis has a widely disseminated and progressive presentation. | ||
*If left untreated, neoplastic meningitis may progress to develop [[seizures]], [[hydrocephalus]], [[encephalopathy]], and ultimately death. <ref name=dcomplicationsnm1>Complications of leptomeningitis. Dr Amir Rezaee and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/leptomeningitis. Accessed on January 21, 2016</ref> | *If left untreated, neoplastic meningitis may progress to develop [[seizures]], [[hydrocephalus]], [[encephalopathy]], and ultimately death. <ref name="dcomplicationsnm1">Complications of leptomeningitis. Dr Amir Rezaee and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/leptomeningitis. Accessed on January 21, 2016</ref> | ||
==Complications== | ==Complications== | ||
Complications of neoplastic meningitis include:<ref name=dcomplicationsnm1>Complications of leptomeningitis. Dr Amir Rezaee and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/leptomeningitis. Accessed on January 21, 2016</ref> | Complications of neoplastic meningitis include:<ref name="dcomplicationsnm1">Complications of leptomeningitis. Dr Amir Rezaee and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/leptomeningitis. Accessed on January 21, 2016</ref> | ||
*[[Hydrocephalus]] | *[[Hydrocephalus]] | ||
*[[Encephalopathy]] | *[[Encephalopathy]] | ||
| Line 23: | Line 23: | ||
==Prognosis== | ==Prognosis== | ||
*The median survival time of patients without treatment of neoplastic meningitis is 4-6 weeks.<ref name=prognosisnm123>Prognosis of neoplastic meningitis. Wikipedia 2016. https://en.wikipedia.org/wiki/Neoplastic_meningitis. Accessed on January 20, 2016</ref> | *The median survival time of patients without treatment of neoplastic meningitis is 4-6 weeks.<ref name="prognosisnm123">Prognosis of neoplastic meningitis. Wikipedia 2016. https://en.wikipedia.org/wiki/Neoplastic_meningitis. Accessed on January 20, 2016</ref> | ||
*Neoplastic meningitis due to breast cancer has the best prognosis, where the median survival time is approximately 6 months after diagnosis.<ref name=prognosisnm123>Prognosis of neoplastic meningitis. Wikipedia 2016. https://en.wikipedia.org/wiki/Neoplastic_meningitis. Accessed on January 20, 2016</ref> | *Neoplastic meningitis due to [[breast cancer]] has the best prognosis, where the median survival time is approximately 6 months after diagnosis.<ref name="prognosisnm123">Prognosis of neoplastic meningitis. Wikipedia 2016. https://en.wikipedia.org/wiki/Neoplastic_meningitis. Accessed on January 20, 2016</ref> | ||
*Favorable prognostic factors for neoplastic meningitis include:<ref name=prognosisnmiugkjh>{{cite journal| last1= Balm | first1= M. | last2= Hammack | first2=J. | title= Leptomeningeal Carcinomatosis Presenting Features and Prognostic Factors| doi=10.1001/archneur.1996.00550070064013.| Date= 01/22/2016}}</ref> | *Favorable prognostic factors for neoplastic meningitis include:<ref name="prognosisnmiugkjh">{{cite journal| last1= Balm | first1= M. | last2= Hammack | first2=J. | title= Leptomeningeal Carcinomatosis Presenting Features and Prognostic Factors| doi=10.1001/archneur.1996.00550070064013.| Date= 01/22/2016}}</ref> | ||
:*Female gender | :*Female gender | ||
:*Longer duration of neurological symptoms | :*Longer duration of neurological symptoms | ||
:*Absence of cerebral leptomeningeal clinical involvement | :*Absence of cerebral [[leptomeningeal]] clinical involvement | ||
:*Absence of elevated CSF protein | :*Absence of elevated [[CSF]] protein | ||
*Poor prognostic factors for neoplastic meningitis include:<ref name=prognosisnm123>Prognosis of neoplastic meningitis. Wikipedia 2016. https://en.wikipedia.org/wiki/Neoplastic_meningitis. Accessed on January 20, 2016</ref> | *Poor prognostic factors for neoplastic meningitis include:<ref name="prognosisnm123">Prognosis of neoplastic meningitis. Wikipedia 2016. https://en.wikipedia.org/wiki/Neoplastic_meningitis. Accessed on January 20, 2016</ref> | ||
:*Negative hormone receptor status | |||
:*Negative [[hormone receptor]] status | |||
:*Poor performance status | :*Poor performance status | ||
:*Multiple fixed neurological deficits | :*Multiple fixed neurological deficits | ||
:*Coexistent carcinomatous encephalopathy | :*Coexistent [[Encephalopathy|carcinomatous encephalopathy]] | ||
:*More than 3 chemotherapy regimes | :*More than 3 [[chemotherapy]] regimes | ||
:*High Cyfra 21-1 level at diagnosis | :*High Cyfra 21-1 level at diagnosis | ||
::*Cyfra 21-1 is a fragment of the cytokeratin-19 and may reflect the tumor burden within the cerebrospinal fluid. | ::*Cyfra 21-1 is a fragment of the [[Cytokeratin|cytokeratin-19]] and may reflect the tumor burden within the [[cerebrospinal fluid]]. | ||
*Neoplastic meningitis patients treated with intra-CSF chemotherapy have a better prognosis.<ref name=prognosisnmiugkjh>{{cite journal | *Neoplastic meningitis patients treated with intra-[[CSF]] chemotherapy have a better prognosis.<ref name="prognosisnmiugkjh">{{cite journal| last= Hammack | first= J. | title= Leptomeningeal Carcinomatosis Presenting Features and Prognostic Factors| doi=10.1001/archneur.1996.00550070064013.| Date= 01/22/2016}}</ref> | ||
==References== | ==References== | ||
Latest revision as of 15:47, 16 August 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]
Overview
Neoplastic meningitis has a widely disseminated and progressive presentation. If left untreated, neoplastic meningitis may progress to develop seizures, hydrocephalus, encephalopathy, and ultimately death. Complications of neoplastic meningitis include hydrocephalus, encephalopathy, empyema, cerebritis, cerebral abscess, and stroke. The median survival time of patients without treatment of neoplastic meningitis is 4-6 weeks.
Natural History
- Neoplastic meningitis has a widely disseminated and progressive presentation.
- If left untreated, neoplastic meningitis may progress to develop seizures, hydrocephalus, encephalopathy, and ultimately death. [1]
Complications
Complications of neoplastic meningitis include:[1]
- Hydrocephalus
- Encephalopathy
- Subdural empyema
- Epidural empyema
- Cerebritis
- Cerebral abscess
- Stroke
- Ventriculitis
- Dural sinus thrombosis
Prognosis
- The median survival time of patients without treatment of neoplastic meningitis is 4-6 weeks.[2]
- Neoplastic meningitis due to breast cancer has the best prognosis, where the median survival time is approximately 6 months after diagnosis.[2]
- Favorable prognostic factors for neoplastic meningitis include:[3]
- Female gender
- Longer duration of neurological symptoms
- Absence of cerebral leptomeningeal clinical involvement
- Absence of elevated CSF protein
- Poor prognostic factors for neoplastic meningitis include:[2]
- Negative hormone receptor status
- Poor performance status
- Multiple fixed neurological deficits
- Coexistent carcinomatous encephalopathy
- More than 3 chemotherapy regimes
- High Cyfra 21-1 level at diagnosis
- Cyfra 21-1 is a fragment of the cytokeratin-19 and may reflect the tumor burden within the cerebrospinal fluid.
References
- ↑ 1.0 1.1 Complications of leptomeningitis. Dr Amir Rezaee and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/leptomeningitis. Accessed on January 21, 2016
- ↑ 2.0 2.1 2.2 Prognosis of neoplastic meningitis. Wikipedia 2016. https://en.wikipedia.org/wiki/Neoplastic_meningitis. Accessed on January 20, 2016
- ↑ 3.0 3.1 Balm, M.; Hammack, J. "Leptomeningeal Carcinomatosis Presenting Features and Prognostic Factors". doi:10.1001/archneur.1996.00550070064013. Check
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