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Related Concept Videos

Bacterial Meningitis I: Introduction01:22

Bacterial Meningitis I: Introduction

Bacterial meningitis is a severe, life-threatening inflammation of the meninges, particularly the pia mater and arachnoid mater, affecting the subarachnoid space, ventricles, and cerebrospinal fluid (CSF). If untreated, it can lead to significant neurological complications or death.Causative AgentsCommon pathogens vary with age and immune status. In adults, major organisms include Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. Streptococcus agalactiae (group B...
Bacterial Meningitis01:24

Bacterial Meningitis

Bacterial meningitis is a severe infectious disease involving inflammation of the meninges, the protective membranes surrounding the brain and spinal cord. It occurs when pathogenic bacteria cross the blood–brain barrier and enter the cerebrospinal fluid. Common causative organisms include Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae type b, Listeria monocytogenes, and Escherichia coli K1. The exact route of entry varies by pathogen and host condition.Routes of Entry...
Viral Meningitis01:18

Viral Meningitis

Viral meningitis is the most common form of meningitis and is often referred to as aseptic meningitis to indicate the absence of bacterial involvement. It is generally milder than bacterial meningitis, with symptoms including fever, headache, stiff neck, drowsiness, nausea, photophobia, and vomiting. Rarely, more severe manifestations or death may occur. Common causative agents include enteroviruses, particularly coxsackie A and B viruses and echoviruses, all members of the Enterovirus genus...
Bacterial Meningitis II: Pathophysiology01:26

Bacterial Meningitis II: Pathophysiology

Bacterial meningitis typically begins when pathogens such as Neisseria meningitidis and Streptococcus pneumoniae colonize the nasopharynx and invade the bloodstream. This process is facilitated by bacterial virulence factors, such as polysaccharide capsules, which resist phagocytosis and complement-mediated killing. Less commonly, bacteria reach the central nervous system via contiguous spread from infections like otitis media or sinusitis, through congenital or acquired dural defects, or...
Cryptococcal Meningitis01:27

Cryptococcal Meningitis

Cryptococcal meningitis is a life-threatening opportunistic infection predominantly associated with HIV/AIDS, accounting for over 100,000 deaths annually worldwide. However, it also affects individuals with other forms of immunosuppression, including those undergoing immunosuppressive therapy, organ transplant recipients, patients with innate immunodeficiencies, and individuals with hematological disorders. The infection is caused mainly by Cryptococcus neoformans and Cryptococcus gattii,...
Encephalitis l: Introduction01:19

Encephalitis l: Introduction

Encephalitis is inflammation of the brain parenchyma, most often due to infections or autoimmune processes. It presents with neuropsychiatric features such as fever, altered mental status, behavioral changes, cognitive dysfunction, seizures, focal deficits, and sometimes autonomic instability. In some cases, the meninges are also involved, resulting in meningoencephalitis.Infectious CausesInfectious encephalitis is most commonly viral but can also result from bacterial, fungal, or parasitic...

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Leptomeningeal neoplasms.

Jan Drappatz1, Tracy T Batchelor

  • 1Jan Drappatz, MD Harvard Medical School, Department of Neurology, Brigham and Women’s Hospital and Dana-Farber/Brigham and Women’s Cancer Center, Center for Neuro-Oncology, 44 Binney Street SW 430, Boston, MA 02115, USA. jdrappatz@partners.org.

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Leptomeningeal metastasis, a cancer complication, occurs when cancer cells spread to the brain and spinal cord via cerebrospinal fluid. Early diagnosis and treatment can improve outcomes for some patients.

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Area of Science:

  • Neuro-oncology
  • Cancer Metastasis

Background:

  • Leptomeningeal metastasis (LM) is an increasing complication of cancer due to improved systemic survival and poor drug penetration into the central nervous system (CNS).
  • LM involves neoplastic cells infiltrating the subarachnoid space via cerebrospinal fluid (CSF) pathways.
  • Diagnosis is confirmed by malignant cells in CSF or leptomeningeal enhancement on MRI.

Purpose of the Study:

  • To review the diagnosis, treatment, and prognosis of leptomeningeal metastasis.
  • To highlight the challenges in CNS drug delivery for cancer patients.

Main Methods:

  • Review of current diagnostic criteria, including CSF cytology and neuroimaging.
  • Discussion of treatment modalities such as radiotherapy, intrathecal chemotherapy, systemic chemotherapy, and surgical shunting.
  • Analysis of prognostic factors and patient outcomes.

Main Results:

  • Prognosis for LM is generally poor, with a median survival of 4 months, though some patients experience prolonged survival.
  • Radiotherapy is indicated for bulky or symptomatic disease.
  • Intrathecal chemotherapy is most effective for lymphoma, leukemia, and breast cancer without bulky disease, requiring normal CSF flow.
  • Systemic chemotherapy may be used for bulky disease.
  • Ventriculoperitoneal shunting can rapidly improve hydrocephalus.

Conclusions:

  • Despite poor prognosis, early diagnosis and aggressive treatment can improve neurologic function and survival in select LM patients.
  • Advances in diagnostics and intrathecal therapies offer hope for improved quality of life and survival.
  • Multidisciplinary management is crucial for optimizing outcomes in leptomeningeal metastasis.