Carcinomatous meningitis

Abstract

Considered as the culmination of metastatic disease, although not exclusive to this phase, it is a  common clinical-pathological complication caused by the dissemination of tumour cells in the meningeal membranes and cerebrospinal fluid. The dissemination takes place through the arachnoid  vessels and by contiguity from the cerebral parenchyma and through the cerebrospinal fluid, the cells  extend in sheet form all over the surface of the central nervous system, where they can also be  grouped into nodules. The areas of preference of deposit are the basal cisterns, Silvio fissure, the  hippocampus region and the lumbar region. It manifests generally with a meningeal and intracranial  hypertension. It implies a short life expectancy, around 3-6 months in patients that receive  chemotherapy. It is an incurable disease in spite of an intensive treatment. Patients with leukaemia,  lymphoma and breast cancer are those that present a greater response to treatment and a longer life  expectancy, around one year1. Occasionally, carcinomatous meningitis represents the first clinical  evidence of cancer (in myeloblastic leukaemia) and should be included in the differential diagnosis in  patients with subacute or chronic neurological manifestations, even when limited to a single level of  neuroaxis.

This disease is a major oncological problem because it is becoming more frequent due to the increase  in survival in certain cancers in which, a control of the disease can be achieved outside the neuroaxis  and it  is precisely in the central nervous system (CNS) where many of the drugs with antitumor  activity do not penetrate due to the presence of a blood-brain barrier, which determines that the CNS is  a "sanctuary" to which these drugs do not have access(2).

An early diagnosis through cerebrospinal fluid (CSF) as well as an early treatment of the disease may  offer the best possibility of symptomatic control and prevention of the establishment of irreversible  neurological deficits that compromise the patient's quality of life to a great extent, also an earlier  treatment might prolong their survival. In spite of this, due to the few and nonspecific symptoms  present in the patients and the low sensitivity and specificity of the information obtained in the  biochemical study of CSF, considered "gold standard" the diagnosis is a challenge. With this method,  negative result is present in more than 45% of the samples. At the present, specific monoclonal  antibodies against identified non-haematological malignancies are increasing, and this information is  especially useful to know the cellular lineage and to diagnose micrometastasis.