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Diagnostic challenges in neoplastic meningitis presenting as intracranial hypertension

Santosh Sriram Andugulapati1, Akash Chheda2, Karan Desai1

  • 1Department of Neurology, Seth GS Medical College and KEM Hospital, Mumbai, Maharastra, India.

BMJ Case Reports
|March 11, 2021
PubMed

Insights

Idiopathic intracranial hypertension requires excluding other causes. Neoplastic meningitis can mimic this condition, highlighting the need for thorough cerebrospinal fluid analysis and whole-body PET-CT scans for diagnosing systemic malignancy.

Area of Science:

  • Neurology
  • Oncology
  • Diagnostic Imaging

Background:

  • Idiopathic intracranial hypertension (IIH) diagnosis necessitates ruling out secondary causes.
  • Neoplastic meningitis is a rare but critical differential diagnosis for IIH.

Observation:

  • A case of neoplastic meningitis presented with symptoms of intracranial hypertension.
  • Cerebrospinal fluid (CSF) cytology and brain MRI results were inconclusive for malignancy.
  • The patient's condition mimicked IIH, delaying definitive diagnosis.

Findings:

  • Meticulous cerebrospinal fluid (CSF) analysis is crucial for identifying malignant cells.
  • Early whole-body positron emission tomography-computed tomography (PET-CT) scan confirmed systemic malignancy.
  • Neoplastic meningitis was confirmed as the underlying cause of intracranial hypertension.

Implications:

  • This case underscores the importance of considering neoplastic meningitis in IIH differential diagnoses.
  • Advanced imaging like whole-body PET-CT plays a vital role in diagnosing occult systemic malignancies.
  • Timely and accurate diagnosis of neoplastic meningitis is essential for appropriate treatment and improved patient outcomes.
Keywords:
coma and raised intracranial pressureheadache (including migraines)neuroimagingneurooncology

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