Neoplastic meningitis physical examination

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

Common physical examination findings of neoplastic meningitis include altered mental status, dementia, hemiparesis, ptosis, nuchal rigidity, bowel and bladder dysfunction, and papilledema.^[1]

Common physical examination findings of neoplastic meningitis include:^[1]

Signs due to cerebral hemisphere dysfunction

• Altered mental status
• Dementia
• Hemiparesis
• Ataxia

Signs due to cranial nerve dysfunction

• Cranial nerve II
  • Optic neuropathy
• Cranial nerve III
  • Ptosis
  • Fixed dilated pupil
  • “Down and out” deviation of the affected eye
• Cranial nerve IV
  • Vertical diplopia
  • Tortional diplopia
• Cranial nerve VI
  • Diplopia
• Cranial nerve V
  • Facial hypesthesia or anesthesia
  • Weakness of clenching and side-to-side movement of the jaw
• Cranial nerve VIII
  • Cochlear dysfunction

Signs due to spinal cord and roots dysfunction

• Limb weakness (lower extremities > upper extremities)
• Sensory loss in the neck and back, following a radicular pattern
• Nuchal rigidity
• Bowel and bladder dysfunction

Signs due to elevated intracranial pressure caused by hydrocephalus

• Papilledema
• Altered mental status

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