Neoplastic Meningitis: A Retrospective Review of
Clinical Presentations, Radiological and
Cerebrospinal Fluid Findings
Sorrawit Jearanaisilp MD*, Tumthip Sangruji MD**,
Chotipat Danchaivijitr MD*, Nasuda Danchaivijitr MD***
Affiliation :
* Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital,
Mahidol University, Bangkok, Thailand
** Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
*** Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : To review the clinical, radiological, and laboratory presentations of patients with neoplastic meningitis.
Material and Method: Patients with neoplastic meningitis were recruited by a retrospective search of cerebrospinal fluid
(CSF) cytopathological report database of Siriraj Hospital between 1997 and 2006. Clinical information and CSF result
of these patients were extracted from their medical records. Neuroimagings were reviewed by a neuroradiologist.
Results : The present study revealed 40 cases of neoplastic meningitis, which comprised of 17 cases with carcinomatous
meningitis (CM) and 23 lymphoma/leukemia meningitis (LM) cases. In patients with CM, the majority (70%) had
adenocarcinoma of lung or breast. Three of 17 cases with unknown primary tumor had carcinomatous meningitis as an
initial presentation. In LM, most of the cases (70%) were diagnosed with acute lymphoblastic leukemia (ALL) and non-
Hodgkin’s lymphoma (NHL). The most common symptom among patients with CM and LM was headache follow by cranial
nerve palsy. In CM cases, CSF cytology was positive in the first specimen in 15 cases (82.35%) and in 22 from 23 cases
(95.7%) in LM cases. Overall CSF showed pleocytosis in 36 cases (90%), most of which were lymphocyte predominant.
The most common findings from brain imagings were leptomeningeal enhancement and hydrocephalus.
Conclusion : The common primary sites were lung and breast cancer in the CM group and ALL and NHL in the LM group.
The common symptoms were headache and cranial nerve palsy. Routine CSF examination was abnormal in virtually all
cases. Positive CSF cytology was a gold standard for a diagnosis of leptomeningeal metastasis. High index of suspicious
and awareness were required to avoid miss diagnosis.
Keywords : Carcinomatous meningitis, Leukemia meningitis, Leptomeningeal meningitis
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