Fischer Stefanie, Weber Johannes, Senn-Schönenberger Isabelle, Cerny Thomas, Hundsberger Thomas
Cantonal Hospital, St Gallen, Switzerland.
Private Practice, St Gallen, Switzerland.
J Investig Med High Impact Case Rep. 2014 Mar 28;2(1):2324709614529417. doi: 10.1177/2324709614529417. eCollection 2014 Jan-Mar.
Leptomeningeal carcinomatosis is a serious complication of advanced cancer. Various clinical manifestations may present, such as headache, nausea, seizures, cranial neuropathies. In this article, we report the case of a 65-year-old woman with metastatic breast cancer who was admitted to hospital suffering from facial palsy, which was suspected to be caused by leptomeningeal tumor infiltration. Magnetic resonance imaging (MRI) scans of the head and spine showed meningeal enhancement of the facial nerve, conus medullaris, and fibers of the cauda equina, which were radiologically interpreted as leptomeningeal carcinomatosis. Assessment of cerebrospinal fluid found no malignant cells but investigation for infectious diseases established the diagnosis of neuroborreliosis. Antibiotic treatment with doxycycline was performed. After completion of treatment, follow-up MRI scans found complete regression of meningeal enhancement. Several months later, the patient is still in good condition and without neurological symptoms. Hence, initial diagnosis of leptomeningeal carcinomatosis was rejected. This case report should alert oncologists to carefully rule out infectious diseases before leptomeningeal carcinomatosis is diagnosed. Cerebrospinal fluid analysis is strongly recommended due to low specificity of MRI images in this regard.
柔脑膜癌病是晚期癌症的一种严重并发症。可能会出现各种临床表现，如头痛、恶心、癫痫发作、颅神经病变。在本文中，我们报告了一例65岁患有转移性乳腺癌的女性患者，她因面神经麻痹入院，怀疑是由柔脑膜肿瘤浸润所致。头部和脊柱的磁共振成像（MRI）扫描显示面神经、脊髓圆锥和马尾神经纤维的脑膜强化，放射学上解释为柔脑膜癌病。脑脊液检查未发现恶性细胞，但传染病检查确诊为神经莱姆病。给予强力霉素抗生素治疗。治疗结束后，随访MRI扫描发现脑膜强化完全消退。几个月后，患者仍状况良好且无神经症状。因此，最初的柔脑膜癌病诊断被否定。本病例报告应提醒肿瘤学家在诊断柔脑膜癌病之前要仔细排除传染病。由于MRI图像在这方面特异性较低，强烈建议进行脑脊液分析。
