title: Patients with malignant meningitis presenting with neuropsychiatric manifestations.
abstract: BACKGROUND
  Malignant meningitis is often thought of as a late event in the course of cancer. At one time, it was thought to be rare, but it has been recognized more frequently in recent times. Clinical suspicion of malignant meningitis is prompted by neurologic symptoms and signs in patients at risk for this oncologic complication. Neuropsychiatric symptoms previously were not considered as presenting symptoms of malignant meningitis.
  
  
  METHODS
  Three patients with cancer with no neurologic symptoms were examined for malignant meningitis based on neuropsychiatric symptoms. Cerebrospinal fluid was examined for malignant cells to confirm the diagnosis of malignant meningitis.
  
  
  RESULTS
  The clinical presentation of malignant meningitis for three patients was neuropsychiatric. None of the patients had delirium during their initial presentation.
  
  
  CONCLUSIONS
  It is important that clinicians recognize that psychiatric symptoms without neurologic findings may indicate malignant meningitis and that malignant meningitis needs to be included in the differential diagnosis of neuropsychiatric disorders in patients with cancer.
authors.affiliation: Department of Neuro-Oncology, University of Texas M. D. Anderson Cancer Center, Houston, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Weitzner
authors.forename: S M
authors.initials: SM
authors.lastname: Olofsson
authors.forename: A D
authors.initials: AD
authors.lastname: Forman
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000150:complications*; D008581:Meningitis / Q000150:complications*; D001523:Mental Disorders / Q000209:etiology*; D008875:Middle Aged