title: Leptomeningeal metastases: comparison of clinical features and laboratory data of solid tumors, lymphomas and leukemias.
abstract: 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.
authors.affiliation: Department of Neurology, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: J G
authors.initials: JG
authors.lastname: Kaplan
authors.forename: T G
authors.initials: TG
authors.lastname: DeSouza
authors.forename: A
authors.initials: A
authors.lastname: Farkash
authors.forename: B
authors.initials: B
authors.lastname: Shafran
authors.forename: D
authors.initials: D
authors.lastname: Pack
authors.forename: F
authors.initials: F
authors.lastname: Rehman
authors.forename: J
authors.initials: J
authors.lastname: Fuks
authors.forename: R
authors.initials: R
authors.lastname: Portenoy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D007938:Leukemia / Q000503:physiopathology*; D008223:Lymphoma / Q000503:physiopathology*; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis / Q000503:physiopathology / Q000556:secondary*; D008875:Middle Aged; D009369:Neoplasms / Q000503:physiopathology*; D009460:Neurologic Examination