[Meningeal carcinomatosis]

Meningeal carcinomatosis is a serious complication of solid tumors, particularly adenocarcinomas of breast, lung and melanoma.

In this paper we present a review of the bibliography on this disease, with particular emphasis on etiopathogenic, clinical--especially otoneurophthalmological--diagnostic and therapeutic aspects.

Meningeal carcinomatosis presents in advanced stages of cancer and has an ominous prognosis with average untreated survival of from four to six weeks. Its frequency has increased in recent years since patients with systemic cancer now live longer. The characteristic of the disease is involvement of various levels of the nervous system, including encephalic, cranial or spinal nerve and spinal symptoms. Sudden loss of vision or hearing which may progress rapidly may be the initial sign of the disease. Neuroimaging studies (computerized axial tomography, magnetic resonance and isotope studies of cerebrospinal fluid flow) are necessary to evaluate associated metastases and detect obstruction of cerebrospinal fluid flow. Positive cerebrospinal fluid cytological findings confirm the diagnosis. Treatment should be tailored to the individual according to the clinical condition and nature of the tumour and should combine intrathecal chemotherapy and local radiotherapy, although recent studies have shown good results with systemic chemotherapy.

A high degree of clinical suspicion is necessary for diagnosis of this uncommon disease, with neurological signs show to be present at different levels and the finding of malignant cells in the cerebrospinal fluid for confirmation of the diagnosis.