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Patients with malignant meningitis presenting with neuropsychiatric manifestations
M A Weitzner1, S M Olofsson, A D Forman
1Department of Neuro-Oncology, University of Texas M. D. Anderson Cancer Center, Houston, USA.
Background:
Malignant meningitis is often thought of as a late event in the course of cancer. At one time, it was thought to be rare, but it has been recognized more frequently in recent times. Clinical suspicion of malignant meningitis is prompted by neurologic symptoms and signs in patients at risk for this oncologic complication. Neuropsychiatric symptoms previously were not considered as presenting symptoms of malignant meningitis.
Methods:
Three patients with cancer with no neurologic symptoms were examined for malignant meningitis based on neuropsychiatric symptoms. Cerebrospinal fluid was examined for malignant cells to confirm the diagnosis of malignant meningitis.
Results:
The clinical presentation of malignant meningitis for three patients was neuropsychiatric. None of the patients had delirium during their initial presentation.
Conclusions:
It is important that clinicians recognize that psychiatric symptoms without neurologic findings may indicate malignant meningitis and that malignant meningitis needs to be included in the differential diagnosis of neuropsychiatric disorders in patients with cancer.
Insights
Malignant meningitis can present with neuropsychiatric symptoms, not just neurological ones. Early recognition of these psychiatric signs is crucial for accurate diagnosis in cancer patients.
Area of Science:
- Neuro-oncology
- Oncology
- Neurology
Background:
- Malignant meningitis, a serious oncologic complication, is increasingly recognized.
- Traditionally, it presents late in cancer and is associated with neurological signs.
Observation:
- This study examined three cancer patients presenting with neuropsychiatric symptoms.
- Malignant meningitis was suspected based on these non-neurological manifestations.
Findings:
- All three patients were diagnosed with malignant meningitis.
- Their initial presentation was characterized by neuropsychiatric symptoms, notably without delirium.
Implications:
- Clinicians should consider malignant meningitis in cancer patients with psychiatric symptoms, even without neurological findings.
- Neuropsychiatric disorders in cancer patients warrant inclusion of malignant meningitis in the differential diagnosis.