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. 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. 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. 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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