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.[1] Complications of neoplastic meningitis include hydrocephalus, encephalopathy, empyema, cerebritis, cerebral abscess, and stroke.[1] The median survival time of patients without treatment of neoplastic meningitis is 4-6 weeks.[2]
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.
- Neoplastic meningitis patients treated with intra-CSF chemotherapy have a better prognosis.[3]
References
- ↑ 1.0 1.1 1.2 1.3 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 2.3 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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