HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by van Oostenbrugge, R. J. Articles by Twijnstra, A. Search for Related Content PubMed PubMed Citation Articles by van Oostenbrugge, R. J. Articles by Twijnstra, A.

Presenting features and value of diagnostic procedures in leptomeningeal metastases

From the Department of Neurology, University Hospital Maastricht, the Netherlands.

Address correspondence and reprint requests to Dr. Robert van Oostenbrugge, Department of Neurology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, the Netherlands; e-mail: rvoo{at}sneu.azm.nl

OBJECTIVE: To study the presenting features and value of routine diagnostic procedures in patients with leptomeningeal metastases (LMM) related to the primary malignancy to improve diagnostic assessment.

METHODS: The authors studied the presenting features and value of routine diagnostic procedures in relation to the histology of primary malignant disease in 45 patients with LMM of solid (n = 30) or hematologic (n = 15) malignancies.

RESULTS: Patients with solid LMM present mostly with spinal or radicular symptoms (53%), whereas patients with hematologic LMM more often show cranial nerve dysfunction at presentation (53%). Multifocal neurologic symptoms were seen in 67% of patients. The first CSF cytology demonstrated malignant cells more frequently in solid LMM compared with hematologic LMM (73% versus 53%). Extralumbar punctures increased the sensitivity of cytology to a greater extent in hematologic LMM than in solid LMM (34% versus 10%). Abnormal neuroimaging findings were found more often in solid LMM than in hematologic LMM (67% versus 40%). Increased total CSF protein in combination with either multifocal neurologic symptoms or abnormal neuroimaging findings was found in 73% of patients with a negative first CSF cytology.

CONCLUSIONS: Patients with LMM presented differently depending on the histology of the primary tumor. In patients with a negative first CSF cytologic examination, multiple lumbar punctures increased the diagnostic accuracy, especially in hematologic LMM. LMM could also be diagnosed in patients with known cancer if total CSF protein was increased in combination with either multifocal neurologic symptoms or abnormal neuroimaging findings, preferably MRI.

This article has been cited by other articles:

				M. C. Chamberlain Neoplastic Meningitis Oncologist, September 1, 2008; 13(9): 967 - 977. [Abstract] [Full Text] [PDF]

				M. C. Chamberlain Neoplastic Meningitis J. Clin. Oncol., May 20, 2005; 23(15): 3605 - 3613. [Abstract] [Full Text] [PDF]

				R. B. Khan, D. D. Giri, M. K. Rosenblum, F. A. Petito, and L. M. DeAngelis Leptomeningeal metastasis from an intracranial epidermoid cyst Neurology, May 22, 2001; 56(10): 1419 - 1420. [Full Text] [PDF]