Optic Neuritis as Isolated Manifestation of Leptomeningeal Carcinomatosis: A Case Report and Systematic Review of Ocular Manifestations of Neoplastic Meningitis
Introduction. Leptomeningeal carcinomatosis occurs in about 5% of cancer patients. Ocular involvement is a common clinical manifestation and often the presenting clinical feature. Materials and Methods. We report the case of a 52-year old lady with optic neuritis as isolated manifestation of neoplastic meningitis and a review of ocular involvement in neoplastic meningitis. Ocular symptoms were the presenting clinical feature in 34 patients (83%) out of 41 included in our review, the unique manifestation of meningeal carcinomatosis in 3 patients (7%). Visual loss was the presenting clinical manifestation in 17 patients (50%) and was the most common ocular symptom (70%). Other ocular signs were diplopia, ptosis, papilledema, anisocoria, exophthalmos, orbital pain, scotomas, hemianopsia, and nystagmus. Associated clinical symptoms were headache, altered consciousness, meningism, limb weakness, ataxia, dizziness, seizures, and other cranial nerves involvement. All patients except five underwent CSF examination which was normal in 1 patient, pleocytosis was found in 11 patients, increased protein levels were observed in 16 patients, and decreased glucose levels were found in 8 patients. Cytology was positive in 29 patients (76%). Conclusion. Meningeal carcinomatosis should be considered in patients with ocular symptoms even in the absence of other suggestive clinical symptoms. 1. Introduction Leptomeningeal carcinomatosis results from dissemination of malignant cells to leptomeninges and can be observed in about 5% of patients with malignancies, but it is likely to become more frequent with the increase of life expectancy in cancer patients [1]. Neoplastic cells may spread to the subarachnoid space through (1) arterial circulation or, less frequently, through (2) retrograde flow in venous systems or (3) as a direct consequence of preexisting brain metastases or (4) through migration of neoplastic cells from the original tumor along perineural or perivascular spaces [2, 3]. Clinical manifestations can be highly variable and may affect both central (CNS) and peripheral nervous system (PNS). CNS involvement may lead to generalised symptoms such as seizures, confusion, encephalopathy, or intracranial hypertension as well as, less frequently, to focal neurological symptoms, mainly consisting in hemiparesis or aphasia. PNS involvement may present with lumbar and cervical radiculopathies or cranial neuropathies [2]. Ocular symptoms even in the absence of other clinical symptoms may represent the initial manifestation of meningeal carcinomatosis. Thus, meningeal
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