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Keeping an open mind about meningitis: a case report of carcinomatous meningitis

Published online by Cambridge University Press:  11 May 2015

Andrew Walkty ,
Burton Abbott ,
Neil Swirsky ,
Janice Safneck  and
John M. Embil
Andrew Walkty*
Affiliation:
Section of Infectious Diseases, Department of Medicine, University of Manitoba Diagnostic Services of Manitoba
Burton Abbott
Affiliation:
Department of Emergency Medicine, University of Manitoba
Neil Swirsky
Affiliation:
Department of Emergency Medicine, University of Manitoba
Janice Safneck
Affiliation:
Department of Emergency Medicine, University of Manitoba Department of Pathology, University of Manitoba, Winnipeg, MB
John M. Embil
Affiliation:
Section of Infectious Diseases, Department of Medicine, University of Manitoba
*
Diagnostic Services of Manitoba, Health Sciences Centre, MS673-820 Sherbrook Street, Winnipeg, MB R3A 1R9; [email protected].

Abstract:

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Carcinomatous meningitis is defined as leptomeningeal infiltration by malignant cells. A case of carcinomatous meningitis, originally diagnosed as viral meningitis, is presented here to highlight the importance of maintaining a broad differential diagnosis in patients with evidence of meningeal irritation. Clinical and laboratory clues that suggest a diagnosis of carcinomatous meningitis in a patient with meningeal irritation include the presence and type of underlying malignancy (more common with breast cancer, lung cancer, and melanoma), absence of fever, presence of radicular pain, evidence of both cranial and spinal involvement, consistent cerebrospinal fluid (CSF) findings (increased opening pressure, elevated protein concentration, decreased glucose, increased white cell count), and supportive neuroimaging. Diagnosis is based on positive CSF cytology results, which may require multiple lumbar puncture procedures to obtain. For patients with a known primary malignancy who present to the emergency department with symptoms and/or signs of meningeal irritation, carcinomatous meningitis should be included in the differential diagnosis.

Keywords

carcinomatous meningitiscerebrospinal fluid cytologymeningitis
Type
Case Report • Rapport De Cas
Information
Canadian Journal of Emergency Medicine , Volume 13 , Issue 5 , September 2011 , pp. 352 - 356
Copyright
Copyright © Canadian Association of Emergency Physicians 2011

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