title: Leptomeningeal signet-ring cell carcinomatosis presenting with ophthalmoplegia, areflexia and ataxia.
abstract: We report a very rare case of occult leptomeningeal carcinomatosis (LC) in whom repeated cytological examination did not show malignant cells in cerebrospinal fluid (CSF) and the primary focus was not discovered by extensive survey. The patient presented with ophthalmoplegia, ataxia and areflexia mimicking Miller Fisher syndrome (MFS) at the initial stage, and later, the clinical profile and laboratory findings including CSF examination simulated tuberculous meningitis. Postmortem autopsy disclosed metastatic signet-ring cell carcinoma infiltrating into cranial nerves and leptomeninges. We would like to emphasize that LC sometimes shows symptoms and signs similar to MFS or tuberculous meningitis.
authors.affiliation: Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan. yuji@neurol.med.osaka-u.ac.jp
authors.forename: Y
authors.initials: Y
authors.lastname: Nakatsuji
authors.forename: S
authors.initials: S
authors.lastname: Sadahiro
authors.forename: S
authors.initials: S
authors.lastname: Watanabe
authors.forename: H
authors.initials: H
authors.lastname: Fujimura
authors.forename: K
authors.initials: K
authors.lastname: Abe
authors.forename: K
authors.initials: K
authors.lastname: Koguchi
authors.forename: S
authors.initials: S
authors.lastname: Sakoda
mesh_terms: D000368:Aged; D001259:Ataxia / Q000209:etiology*; D018279:Carcinoma, Signet Ring Cell / Q000473:pathology / Q000556:secondary*; D002552:Cerebral Ventricles / Q000473:pathology; D003937:Diagnosis, Differential; D006801:Humans; D007002:Hypoglossal Nerve / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology / Q000556:secondary*; D008578:Meninges / Q000473:pathology; D009382:Neoplasms, Unknown Primary / Q000473:pathology*; D009886:Ophthalmoplegia / Q000209:etiology*; D012021:Reflex, Abnormal / Q000502:physiology*