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An unusual case of headache
Victor S H Wang1, Phil Tuch, Christina C K Wang
1Department of Neurology, Royal Perth Hospital, Wellington Street Campus, Box X2213 GPO, 6847, Perth, Australia.
Summary
Carcinomatous meningitis, a rare complication of solid tumors, can initially mimic common conditions like migraine or viral meningitis. This case highlights the importance of considering malignancy in persistent, unexplained headaches, especially with neurological signs.
Area of Science:
- Neurology
- Oncology
Background:
- Carcinomatous meningitis is a rare complication of solid tumors, affecting 3-5% of patients.
- It often presents insidiously, making early diagnosis challenging.
Observation:
- A 44-year-old woman presented with a 3-week history of subacute headache, initially diagnosed as migraine or viral meningitis.
- Her condition progressed to include a 6th cranial nerve palsy, diplopia, and generalized tonic-clonic seizures.
Findings:
- Diagnosis of carcinomatous meningitis was confirmed via cerebrospinal fluid (CSF) cytology after repeated lumbar punctures.
- The patient received palliative care including CSF drainage and chemotherapy.
Implications:
- This case underscores the need for a high index of suspicion for carcinomatous meningitis in patients with persistent headaches and evolving neurological deficits.
- Timely diagnosis and management are crucial, although prognosis remains poor in advanced stages.