Neoplastic meningitis: clinico-radiological features, outcome and prognostic factors
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Date
2010
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Journal ISSN
Volume Title
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NEUROLOGY ASIA
Abstract
Objective: This retrospective hospital based study aimed to describe clinico-radiological features and outcome of neoplastic meningitis (NM) and to evaluate the significance of the presence of malignant cells in CSF and identifiable 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 clinico-radiological 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 1(st) to 3(rd) lumbar punctures. A primary could be identified 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 significantly less in cytology positive group (p=0.001). The relative risk of survival at 90 days, 120 and 150 days were significantly higher in cytology and primary negative group compared to positive group. Conclusion: NM with positive cytology or with an identifiable 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.
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Keywords
Neurosciences & Neurology
Citation
15 ,1;71-77