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Three cases of neoplastic meningitis initially diagnosed with infectious meningitis in emergency department

Shin Ahn1, Kyung Soo Lim

  • 1Department of Emergency Medicine, Asan Medical Center, College of Medicine, University of Ulsan, 388-1, Pungnap-dong, Songpa gu, Seoul, 138-736, Republic of Korea.

Case Reports in Emergency Medicine
|July 11, 2013
PubMed

Insights

Neoplastic meningitis (NM) can be misdiagnosed as infectious meningitis in the emergency department (ED). Early recognition of malignant cells in cerebrospinal fluid (CSF) is crucial for accurate NM diagnosis.

Area of Science:

  • Neurology
  • Oncology
  • Pathology

Background:

  • Neoplastic meningitis (NM) involves malignant cells in cerebrospinal fluid (CSF).
  • Misdiagnosis of NM as infectious meningitis can occur in emergency settings.
  • Headache is a common presenting symptom for NM.

Purpose of the Study:

  • To highlight the critical need for considering neoplastic meningitis (NM) in the differential diagnosis of meningitis.
  • To present cases where NM was initially misdiagnosed as infectious meningitis.
  • To emphasize the importance of cerebrospinal fluid (CSF) cytology in diagnosing NM.

Main Methods:

  • Case series reporting three patients with neoplastic meningitis (NM).
  • Review of initial diagnoses in the emergency department (ED) versus subsequent confirmed diagnoses.
  • Analysis of diagnostic procedures including MRI and CSF examination (cytology).

Main Results:

  • Three patients initially diagnosed with infectious or other forms of meningitis were found to have neoplastic meningitis (NM) upon further CSF examination.
  • Delayed diagnosis of NM occurred in all reported cases.
  • Malignant cells in CSF confirmed NM in all three patients, with primary cancers identified as lung, stomach, and unknown.

Conclusions:

  • Neoplastic meningitis (NM) should be a key differential diagnosis for patients presenting with meningitis symptoms, particularly headache, in the emergency department (ED).
  • Cerebrospinal fluid (CSF) cytology is essential for accurate NM diagnosis.
  • Prompt identification and diagnosis of NM are critical for appropriate patient management.

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