[Meningeal carcinomatosis. A case report.]

We describe a 69 year old man presenting with acute confusional state as the first symptom of meningeal carcinomatosis complicating adenocarcinoma of the lung. For three weeks preceding the admission the patient was intermittently and increasingly confused and short term memory was clearly impaired but normal in-between. The patient stopped working one week prior to admission because of the mental changes. He also had two months history of increasing neck pain. He was otherwise well except for history of mild hypertension. General physical examination and neurological examination were essentially unremarkable except for somewhat distant affect and he was fully oriented and without aphasia. The patient was somewhat uncooperative and left the emergency room against medical advice after a spinal tap had been done. The cerebrospinal fluid was markedly abnormal showing slight increase in mono-nucleated white cells (22/M1), markedly elevated protein (3.4 g/1 (0.2-0.4)) and decreased glucose con notcentration (0.8 mmol/1 (2.5-4.0)). The patient was immediately readmitted to the hospital and the differential diagnosis of fungal, tuberculous or neoplastic meningitis was considered based on the cerebrospinal fluid (CSF) findings. Chest X-ray demonstrated a lesion in the right upper lobe and repeated CSF exa notmination showed neoplastic cells forming gland like structures. Lung biopsy demonstrated adenocarcinoma. The clinical condition of the patient worsened rapidly and he died five days after admission.