Leptomeningeal metastasis from systemic cancer.

PURPOSE OF REVIEW

Leptomeningeal metastasis (LM) is an uncommon, usually late, complication of cancer. This article discusses the clinical presentation, diagnosis, prognosis, and treatment of LM.

RECENT FINDINGS

Neither gadolinium-enhanced MRI nor CSF cytology is adequately sensitive to diagnose all cases of LM.

SUMMARY

Patients with LM classically present with multifocal neurologic symptoms and signs, and the diagnosis is made via MRI, CSF cytologic analysis, or both. Treatment is palliative in nature and can involve focal radiation to symptomatic sites, systemic chemotherapy with agent(s) that cross the blood-brain barrier, or intrathecal delivery of chemotherapy. Patients may present with or later develop signs of hydrocephalus; ventriculoperitoneal shunting can provide symptomatic relief in certain patients. Overall prognosis is poor, with a median survival typically in the range of 2 to 3 months.