Japanese Journal of Clinical Oncology 2006 36(10):676; doi:10.1093/jjco/hyl131
© 2006 Foundation for Promotion of Cancer Research
Cases with Carcinomatous Meningitis and Cerebral Infarction
Yoshitaka Narita and
Soichiro Shibui
Neurosurgery Division, National Cancer Center Hospital, Tokyo, Japan
A 34-year-old female with a history of breast cancer complained of headache, nausea and left hemiparesis. Magnetic resonance imaging (MRI) with Gd-DTPA showed an enhancement of the cerebral sulci (Fig. 1). Lumbar-puncture examination revealed that the number of atypical cells (779/3) and the protein concentration (776 mg/dl) increased in the cerebral spinal fluid (CSF). She was diagnosed as carcinomatous meningitis and the treatment with intrathecal application of methotrexate was performed.
A 49-year-old female with a history of ovarian cancer complained
of sudden onset of weakness of the right lower limb. MRI with
Gd-DTPA a few days after attack showed the enhancement of the
limited area in the cerebral gyrus (
Fig. 2). The results of
CSF examination were normal (cells < 3/3, protein < 30
mg/dl) even with three times of the examinations. She was diagnosed
as cerebral infarction and the right hemiparesis was improved
without any specific treatment about two weeks after the onset
of the symptom.
The differential diagnoses among cerebral infarction, carcinomatous
meningitis and brain tumor are sometimes difficult in cancer
patients. The cerebellar corteces and sulci are more enhanced
on MRI with Gd-DTPA compared to the cerebral sulci in patients
with carcinomatous meningitis. The infarct area is also enhanced
with Gd-DTPA on MRI
24 h after the onset and it is sometimes
misdiagnosed as a brain tumor. The history of neurological symptoms
and the results of CSF are very important for the differential
diagnosis of these diseases.
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