Carcinomatous meningitis: Current insights into diagnosis, prognosis and management

Carcinomatous meningitis, or leptomeningeal metastasis, is a severe neurological complication of solid and haematological malignancies caused by dissemination of tumour cells within the leptomeninges and cerebrospinal fluid pathways. Clinical presentation is heterogeneous, including headache, intracranial hypertension, cranial nerve palsies or radiculopathy, which frequently leads to diagnostic delay. Diagnosis relies on converging clinical, radiological, and cerebrospinal fluid findings, with gadolinium-enhanced magnetic resonance imaging of the brain and spine and cerebrospinal fluid cytology remaining central despite imperfect sensitivity. Emerging tools, particularly cerebrospinal fluid circulating tumour cells and circulating tumour DNA, may improve early detection and molecular characterisation. Prognosis remains poor, with survival usually measured in months. Management should be individualised according to performance status, tumour subtype, and systemic disease control, and may combine symptomatic measures, radiotherapy, targeted systemic therapies, and, in selected patients, intrathecal chemotherapy. Early integration of palliative care remains a key component of management.