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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Meningeal carcinomatosis is characterized by diffuse infiltration of the leptomeninges by metastatic cancer in patients usually with a previous history of malignancy. Primary tumors are usually adenocarcinomas of the breast or lung, or malignant melanoma. Meningeal carcinomatosis can present with headache and/or a variety of cranial neuropathies. We report a case of meningeal carcinomatosis presenting as a complete, bilateral, sudden hearing loss without other cranial nerve findings--a previously unreported presentation. Our patient also exhibited an unusual primary tumor site (esophagus) and histopathology for meningeal carcinomatosis. The case was impressive for the subsequent abrupt onset of a series of cranial neuropathies and the rapid deterioration in the patient's condition.
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PMID:Meningeal carcinomatosis producing bilateral sudden hearing loss: a case report. 141 3

Head and neck cancer has rarely been reported to be a cause of meningeal carcinomatosis. These tumors are known more for their local invasiveness rather than distant metastasis. This would appear to preclude meningeal involvement, but close proximity to multiple cranial nerves may provide an access to the meninges. Six cases of head and neck cancer with meningeal invasion are presented. All six cases had malignant cells in their cerebrospinal fluid. Three cases had malignant cells recovered from a ventricular specimen after lumbar punctures were negative. The most common clinical finding on presentation was cranial nerve involvement. The optic nerve was involved most often with nerves VI and V the next most frequent. Headache was present in four patients and seizures occurred in two. No patient had meningismus. Our current treatment plan involves insertion of an Ommaya Reservoir and intraventricular methotrexate. Only patients whose primary head and neck tumor shows a response to systemic therapy undergo Ommaya placement. Meningeal carcinomatosis in head and neck cancer may be more prevalent than previously thought and the likely mechanism is via direct extension rather than hematogenous spread.
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PMID:Meningeal carcinomatosis in head and neck cancer. Report of six cases and review of the literature. 377 15

The sites of metastases of transitional cell carcinoma of the bladder are nodes, liver, lung and bone, but the meningeal infiltration is rare. Therefore, one case of meningeal carcinomatosis is reported. After cystectomy for an undifferentiated carcinoma of the bladder, the patient received adjuvant chemotherapy. Three months after treatment completion, symptoms of cerebellar ataxia occurred and gradually confusion appeared. The initial cerebra spinal fluid showed clumps of malignant cells. The patient died 15 days after the neurological symptoms occurred. The clinical diagnosis of meningeal carcinomatosis is based on neurological manifestations at more than one level of the neuraxis. Symptoms may present simply as headache or confusion. Meningeal carcinomatosis from urothelial cancer seems to show some specific features: poorly differentiated tumour and high frequency of cerebellar symptoms. Intrathecal treatment essentially has a pain-effect. Mean survival time is as short as 20 weeks. The increasing incidence of this neurological complication in urothelial cancer does not only result from an increase in patient longevity but also from possible side-effects of chemotherapy, so as localized changes in blood-brain barrier permeability induced by antineoplastic drugs. Therefore, we may wonder whether meningeal carcinomatosis might not be regarded as an iatrogenic effect.
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PMID:[Carcinomatous meningitis: rare complication of bladder cancer]. 918 49

Meningeal carcinomatosis is an uncommon complication in patients with advanced gastric cancer. We report four cases of meningeal carcinomatosis occurring 18 months (mean) after the diagnosis. The presenting manifestations were headache, visual troubles and seizure. Cytological cerebrospinal fluid (CSF) examination was the most useful diagnostic tool for leptomeningeal carcinomatosis, considering the normality of brain CT scan and MRI in our patients. Intrathecal methotrexate administration achieved a rapid improvement in neurological symptoms in all cases, but for a short 2-3 months duration. We conclude that survival improvement in advanced gastric cancer, due to chemotherapy, may allow emergence of unusual complications such as carcinomatous meningitis. This diagnosis should be evoked in the presence of unexplained neurologic symptoms and confirmed by CSF examination in order to propose a treatment and to delay serious neurologic disability and prolong survival.
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PMID:[Meningeal carcinomatosis in gastric cancer]. 1144 30

Gastric adenocarcinoma is rarely observed in patients under the age of 40. Meningeal carcinomatosis as a first manifestation of disease is absolutely unique. If meningeal involvement occurs it is usually secondary event in previously diagnosed tumor. The prognosis is very unfavorable associated with short term survival. In the treatment of this disease there night be used either chemotherapy administered via lumbar injection or radiotherapy or combination of both. This case study is one of very few cases reported in literature when meningeal carcinomatosis was a first sign of advanced gastric adenocarcinoma. 39 years old woman was admitted to our hospital with severe headache, diplopia and vomiting. Meningeal carcinomatosis with gastric primary was diagnosed. She was treated with combination of cytosine arabinosid (Cytosar), methotrexate (Methotrexat), hydrocortisone (Hydrocortisone) administered via intrathecal lumbar injection and whole brain radiation. As a main complication she experienced disseminated intravascular coagulopathy. The improvement of patient's condition following the initial treatment had a very limited duration and the patient died of bilateral pneumonia and cerebral edema 44th day after the admission.
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PMID:[Meningeal carcinomatosis as the first manifestation of gastric adenocarcinoma]. 1178 14

Carcinomatous meningitis, also known as leptomeningeal metastasis and meningeal carcinomatosis, is the invasion of neoplastic cells into the leptomeninges. Head and neck cancers, especially nasopharyngeal carcinoma, give rise to carcinomatous meningitis very infrequently. In this case report, we present a rare case of carcinomatous meningitis with nasopharyngeal carcinoma as the primary source. In 1987, a 45-year-old white female presented with a few year history of chronic bilateral serous otitis media. She also complained of intermittent diplopia, right facial pain, right-sided headache, and, finally, right facial palsy. The patient was subsequently diagnosed with nasopharyngeal carcinoma by biopsy and treated with radiation as well as chemotherapy. Her neurological symptoms improved, and she did fairly well for several years. However, various neurologic symptoms started to recur, including right facial weakness, right facial numbness in the distribution of all 3 divisions of cranial nerve (CN) V, loss of taste as well as smell, and diplopia. In 1993, magnetic resonance imaging scan of the head revealed recurrence of nasopharyngeal carcinoma with involvement of the ethmoid sinuses as well as extension of the tumor into the frontotemporal leptomeninges. Over the course of the next 3 years, the patient experienced a very gradual decline with involvement of almost all of the CNs (CN I, II, III, V, VI, VII, VIII, IX, X, XII). This case report of carcinomatous meningitis from primary nasopharyngeal carcinoma is one of the few reported in the literature. Although very rare, nasopharyngeal carcinoma can give rise to carcinomatous meningitis, probably by direct invasion of malignant cells. We also review the literature with respect to the diagnosis and treatment of carcinomatosis meningitis.
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PMID:Carcinomatous meningitis arising from primary nasopharyngeal carcinoma. 1585 76

Carcinomatous meningitis (CM) occurs in less than 10% of cancer patients. Although patients frequently present with a focal complaint, multifocal signs are often found following careful neurological examination. The gold standard for diagnosis remains the demonstration of neoplastic cells in the cerebrospinal fluid. Despite the discouraging prognosis, palliative treatment may improve quality of life and lengthen lifespan. We report a patient with known primary carcinoma of the urachus who presented with headaches, nausea, vomiting and ataxia 1 week following resection of a nodular arachnoidal metastasis (indenting the cerebellum). Lumbar cerebrospinal fluid subsequently confirmed carcinomatous meningitis. This is the first reported case of carcinomatous meningitis resulting from metastatic urachal carcinoma.
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PMID:Carcinomatous meningitis from urachal carcinoma: the first reported case. 1630

Carcinomatous meningitis is a severe complication of lung cancer. Although treatment with gefitinib, a tyrosine kinase inhibitor of epidermal growth factor (EGF) receptor, has been reported to be highly effective against lung cancers harboring a mutated EGF gene, its effect against carcinomatous meningitis is unknown. Here, we report successful treatment of carcinomatous meningitis with gefitinib in a lung cancer patient suffered from meningeal metastasis. A 62-year-old, non-smoking, Japanese male was admitted for headache, failing vision, and temporary loss of consciousness and was subsequently diagnosed with stage IV lung adenocarcinoma and carcinomatous meningitis. A tumor sample revealed the in-frame deletion of codons 746 to 750 (E746 to A750) in exon 19 of the EGF gene, which leads to constitutive activation of the tyrosine kinase domain and high-affinity binding of gefitinib. The patient's performance status was poor owing to progression of the meningitis and elevated cerebrospinal fluid (CSF) pressure. Combined treatment with gefitinib (250 mg/day) and whole-brain irradiation (36 Gray total) proved to be effective. It is noteworthy that the level of gefitinib in the CSF was less than 1% of the serum level (serum: 117 nM before drug re-administration and 132 nM 2 hrs later; CSF: 0.9 nM both before and 2 hrs after drug re-administration). Gefitinib treatment should be considered for patients with carcinomatous meningitis and lung adenocarcinoma harboring a mutated EGF gene.
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PMID:Successful treatment of carcinomatous meningitis with gefitinib in a patient with lung adenocarcinoma harboring a mutated EGF receptor gene. 1844 12

Meningeal carcinomatosis (MC) is a malignant infiltration of the leptomeninges and subarachnoid space and can be a devastating complication of a systemic malignancy. Although often found in patients with known metastatic malignancies, MC can also be the initial manifestation of an underlying malignancy. We report four case studies where back pain, dizziness, cognitive decline, headache and headache with the cranial nerve VI palsy were the first signs of MC. In two cases, adenocarcinoma ventriculi was found, in other one, the markers of the gastrointestinal tract malignancy were highly positive but malignity was not found, and in the last one, there was a known breast carcinoma. The diagnosis of MC requires the finding of malignant cells in the cerebrospinal fluid, but sometimes several lumbar punctures are required to establish the diagnosis, and also MRI with gadolinium. Finally, we would like to highlight the fact that markedly decreased glycorrhachia in cerebrospinal fluid (CSF) can also be the first sign of MC (Fig. 6, Tab. 2, Ref. 23).
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PMID:Meningeal carcinomatosis as the first manifestation of malignant carcinomatosis. 1975 Sep 88

The development of chemotherapy to treat gastric cancer has prolonged its prognosis, and sometimes extremely rare conditions arise. This report describes two patients with carcinomatous meningitis who rapidly progressed into unconsciousness and died. A 60-year-old woman under second-line chemotherapy for gastric cancer presented with headache and disordered speech. Magnetic resonance imaging (MRI) indicated carcinomatous meningitis, and a lumbar puncture revealed cancer cells in the cerebrospinal fluid. Convulsions rapidly progressed while unconscious, and the patient died two weeks after admission. A 67-year-old man receiving adjuvant chemotherapy after total gastrectomy for gastric cancer was admitted to the emergency department with severe fatigue and appetite loss. Unconsciousness rapidly progressed on the following day and carcinomatous meningitis was diagnosed. The patient died two weeks later. Carcinomatous meningitis is a rare complication of gastric cancer that rapidly progresses often to death, and it should be recalled that it is accompanied by a rapid loss of consciousness.
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PMID:[Carcinomatous meningitis in gastric cancer under chemotherapy-two cases]. 2000 73


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