Search

Leptomeningeal metastasis (LM) of systemic malignancy often give rise to multifocal involvement of the central (CNS) and peripheral nervous system. Signs of CNS dysfunction such as seizures and confusion often overshadow radicular deficits. We report clinical and laboratory evaluations in 10 patients with LM who presented with isolated polyradiculopathy. Our data suggest that electromyography and late response studies are sensitive indicators of radicular dysfunction in patients with LM. These studies are helpful in the early documentation of root involvement when computerized tomography, MRI and myelography are normal.

We reviewed 63 cases of cytologically confirmed leptomeningeal metastases (LM). 31 (49%) had solid tumors 17 (27%) had leukemia and 15 (24%) had lymphoma. The most common presenting symptom was pain (76%) with radicular discomfort (58%), headache (32%), neck or back pain (17%). The predominant neurological signs were mental status abnormalities (49%), weakness (47%), seizures (14%). The mode of presentation varied with tumor type. Patients with leukemia (18%) and lymphoma (13%) tended to present frequently with LM without systemic involvement, or during periods of apparent remission (leukemia 35%, lymphoma 27%), while patients with solid tumors had established systemic metastases (90%) at time of presentation. Laboratory studies did not vary among the groups. 71% had positive cytology on the first lumbar puncture (LP) and only 8% required more than 2 LPs. The cell count was a poor predictor of positive cytology as 29% of LP's with positive cytology and 36% of all LP's had less than 4 cells/mm. We conclude that 1) LM presents with pain and seizures more frequently than has been previously recognized; 2) LM is frequently the mode of presentation in patients with leukemia and lymphoma and; 3) cytology is positive frequently in CSF specimens with normal cell counts and chemistries.