Ahn Shin, Lim Kyung Soo
Department 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 Rep Emerg Med. 2013;2013:561475. doi: 10.1155/2013/561475. Epub 2013 Jun 6.
Neoplastic meningitis (NM) is diagnosed by the presence of malignant cells in the cerebrospinal fluid (CSF). We report 3 patients with NM, who were misdiagnosed with infectious meningitis in emergency department (ED). Case 1. A 68-year-old man visited our ED with a 3-month history of headache. With MRI and CSF study, he was diagnosed with tuberculous meningitis. After 20 days, repeated CSF cytology showed malignant cells. His diagnosis was lung cancer with NM. Case 2. A 57-year-old man visited regional hospital ED with a 3-week history of headache and diplopia. Brain MRI was not contributory. With CSF examination, his diagnosis was aseptic meningitis. With worsening headache, he was referred to our ED. Repeated CSF showed malignant cells. His diagnosis was stomach cancer with NM. Case 3. A 75-year-old man visited a regional hospital with headache lasting for 4 months. His diagnosis was sinusitis. Persistent symptom brought him back, and he developed recurrent generalized seizures. Brain MRI showed diffuse leptomeningeal enhancement suggesting meningitis, and he was transferred to our ED. CSF exam showed malignant cells. His diagnosis was NM with unknown primary focus. When evaluating the patients with headache in ED, NM should be kept in mind as a differential diagnosis of meningitis.
肿瘤性脑膜炎（NM）通过脑脊液（CSF）中存在恶性细胞来诊断。我们报告3例NM患者，他们在急诊科（ED）被误诊为感染性脑膜炎。病例1。一名68岁男性因头痛3个月就诊于我院急诊科。经磁共振成像（MRI）和脑脊液检查，他被诊断为结核性脑膜炎。20天后，重复脑脊液细胞学检查发现恶性细胞。他的诊断为肺癌合并NM。病例2。一名57岁男性因头痛和复视3周就诊于地区医院急诊科。脑部MRI检查无诊断价值。经脑脊液检查，他的诊断为无菌性脑膜炎。随着头痛加重，他被转诊至我院急诊科。重复脑脊液检查发现恶性细胞。他的诊断为胃癌合并NM。病例3。一名75岁男性因头痛持续4个月就诊于一家地区医院。他的诊断为鼻窦炎。持续的症状使他再次就诊，随后出现反复发作的全身性癫痫。脑部MRI显示软脑膜弥漫性强化提示脑膜炎，他被转至我院急诊科。脑脊液检查发现恶性细胞。他的诊断为原发灶不明的NM。在急诊科评估头痛患者时，应将NM作为脑膜炎的鉴别诊断之一予以考虑。
