Neoplastic meningitis natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

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.

• 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 of neoplastic meningitis include:^[1]

• Hydrocephalus
• Encephalopathy
• Subdural empyema​
• Epidural empyema
• Cerebritis
• Cerebral abscess
• Stroke
• Ventriculitis
• Dural sinus thrombosis

• 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]

Template:WikiDoc Sources