Leptomeningeal Disease
About Leptomeningeal Disease
A leptomeningeal tumor — also called leptomeningeal carcinomatosis, leptomeningeal metastasis, neoplastic meningitis, meningeal metastasis and meningeal carcinomatosis — refers to cancer that has spread from the original tumor to the meninges, the thin layers of tissue that cover and protect the brain and spinal cord, causing the meninges to become inflamed. This can happen with any type of cancer (it occurs in about three to five percent of cancer patients) but is most common in melanoma, breast, lung and gastrointestinal cancer cases.
There is evidence that cases of central nervous system metastases, including leptomeningeal tumor, are increasing because modern medicine has prolonged the survival of cancer patients, giving the primary tumor a chance to spread to the meninges. The prognosis is poor for these tumors, with the median survival being about three months after diagnosis. Treatment is ineffective because the tumor is hard to eradicate, though radiation therapy and chemotherapy may have some palliative benefits.
Symptoms
General signs and symptoms of leptomeningeal disease include those associated with brain pressure. These may include headaches, changes in mental status, nausea and vomiting, difficulty with balance, seizures and papilledema. Cranial nerve symptoms including visual loss, diplopia, hearing loss, dysphagia, ocular muscle weakness, facial weakness and facial pain are also seen. For patients with spinal LMD, radicular pain, weakness and paresthesias are also common,
Risk Factors
Leptomeningeal disease occurs when tumor cells infiltrate the cerebrospinal fluid pathways and travel various parts of the brain and spinal cord and begin to grow. Even though this disease is often assumed to be fatal, patients have benefited greatly from a combination of surgery, radiation and chemotherapy.