Neoplastic meningitis: clinico-radiological features, outcome and prognostic factors
- Author:
Ramesha KN
;
Mahesh P Kate
;
C Kesavadas
;
VV Radhakrishnan
;
Sankara P Sarma
;
Sanjeev V Thomas
- Publication Type:Journal Article
- From:Neurology Asia
2010;15(1):71-77
- CountryMalaysia
- Language:English
-
Abstract:
Objective: This retrospective hospital based study aimed to describe clinico-radiological features and
outcome of neoplastic meningitis (NM) and to evaluate the signifi cance of the presence of malignant
cells in CSF and identifi able primary in NM. Methods: The diagnosis of NM was based on the presence
of malignant cells in CSF cytology, meningeal biopsy, post mortem examination or compatible clinicoradiological
features in patients with known primary malignancy. For subgroup comparisons, Mann
Whitney test and Fisher’s exact test were used for continuous and categorical variables respectively.
Relative risk of survival in positive CSF cytology for malignant cells and known primary versus
negative were calculated. Results: There were 25 patients (mean age 44.5 + 17.6 years) of NM during
the study period (2000-2008). They presented with raised ICP headache (72%), cauda equina syndrome
(28%), or hemiparesis (12%). Meningeal enhancement and hydrocephalus were seen in 60% and 21%
respectively. CSF analysis revealed hypoglychorrachia (64%), raised protein (68%) and pleocytosis
(48%). CSF cytology for malignant cells was positive in 76% and cumulative positivity increased
by 31% from 1st to 3rd lumbar punctures. A primary could be identifi ed in 56% cases. At last follow
up, 16 out of 18 had died. Hypoglychorrachia was the only variable analyzed, which predicted the
cytology positivity (p=0.01). The mean duration of survival from the onset was signifi cantly less in
cytology positive group (p=0.001). The relative risk of survival at 90 days, 120 and 150 days were
signifi cantly higher in cytology and primary negative group compared to positive group.
Conclusion: NM with positive cytology or with an identifi able primary tumor has a more aggressive
course when compared to the negative groups and former have shorter lifespan. The possibility of
positive cytology is high with hypoglychorrachia.
- Full text:P020150902371198019415.pdf
