Leptomeningeal disease may also be referred to as carcinomatous meningitis or neoplastic meningitis.
Diagnosis is usually made with a combination of an MRI andspinal tap.
Symptoms
The symptoms of leptomeningeal carcinomatosis can vary significantly, and often include numerous neurological problems.
Verywell / Emily Roberts
Doctors use the term “multifocal deficits” to describe the variety of symptoms that may occur.
For example, a person may have symptoms (described below) of encephalopathy as well as a radiculopathy.
Injury (such as compression) of the spinal nerve root will often create symptoms in another region.
The cardinal symptom is an altered mental state.
Other neurological symptoms may occur as well depending on the location of the blockage.
Brain metastases in some locations in the brain will have no symptoms.
A high index of suspicion is necessary to ensure that the appropriate tests are run for a timely diagnosis.
On an MRI, radiologists can see inflamed meninges and any co-existing brain metastases.
Before this test, doctors carefully review the MRI to ensure that a spinal tap will be safe.
This study can determine whether blockages have occurred in the flow of CSF due to the tumor.
Differential Diagnosis
A number of conditions can mimic leptomeningeal metastases and cause similar signs and symptoms.
Leptomeningeal metastases are challenging to treat for several reasons.
For this reason, people with the disease may be less able to tolerate treatments such as chemotherapy.
As with brain metastases, the blood-brain barrier poses problems in treatment.
Some targeted therapies and immunotherapy drugs, however, can penetrate this barrier.
Most often, fractionated external beam radiation is directed toward areas where clusters of cancer cells are causing symptoms.
This is referred to as intraventricular, CSF, orintrathecal chemotherapy.
Intrathecal chemotherapy was once administered via a spinal tap needle.
This reservoir is left in place for the duration of chemotherapy treatment.
Some systemic treatments penetrate the blood-brain barrier and can be helpful with leptomeningeal metastases.
In these instances, palliative care can still help tremendously with managing symptoms.
That said, some people who are otherwise in reasonable health and can tolerate treatments do very well.
A Word From Verywell
A diagnosis of leptomeningeal metastases can be heart-wrenching.
As survival rates from other cancers improve, more people are having to cope with this complication.
Fortunately, recent advances in cancer therapies promise more options for effective treatment.
It’s important to talk to your oncologist about your individual situation today.
Batool A, Kasi A.Leptomeningeal carcinomatosis.
In:StatPearls[Internet].
Treasure Island FL: StatPearls Publishing.
2013;4(Suppl 4):S265-88.
doi:10.4103/2152-7806.111304
Johns Hopkins Medicine Health Library.Radiculopathy.
National Institute of Neurological Disorders and Stroke.Encephalopathy information page.
2015;3:41. doi:10.1186/s40425-015-0084-y
Cheng H, Perez-Soler R.Leptomeningeal metastases in non-small-cell lung cancer.Lancet Oncol.
2018;19(1):E43-E45.
