Neoplastic meningitis natural history, complications and prognosis

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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]

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.

Neoplastic meningitis patients treated with intra-CSF chemotherapy have a better prognosis.^[3]

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 |doi= value (help). Unknown parameter |Date= ignored (|date= suggested) (help)

Template:WikiDoc Sources

[dcomplicationsnm1-1] 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

[prognosisnm123-2] 2.0 ^2.1 ^2.2 Prognosis of neoplastic meningitis. Wikipedia 2016. https://en.wikipedia.org/wiki/Neoplastic_meningitis. Accessed on January 20, 2016

[prognosisnmiugkjh-3] 3.0 ^3.1 Balm, M.; Hammack, J. "Leptomeningeal Carcinomatosis Presenting Features and Prognostic Factors". doi:10.1001/archneur.1996.00550070064013. Check |doi= value (help). Unknown parameter |Date= ignored (|date= suggested) (help)

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