Diplopia in a patient with carcinomatous meningitis: a case report and review of the literature.
In a patient with a history of malignancy, an isolated neurologic sign or symptom may indicate metastasis to the central nervous system. To exclude this possibility, a lumbar puncture should still be performed after a nondiagnostic cranial computed tomography (CT) scan even in the absence of signs of infection. A case is presented of a 59 year-old man recently diagnosed with non-Hodgkin's lymphoma that presented to the Emergency Department (ED) with the sole complaint of diplopia. Examination was unremarkable except for a left abducens nerve palsy. Cranial CT scan was normal but initial cerebrospinal fluid results were suggestive of carcinomatous meningitis, and cytology results later confirmed this diagnosis. A review of diplopia and carcinomatous meningitis is presented, along with a suggested conservative diagnostic algorithm for cancer patients presenting with neurologic signs or symptoms.
Chang
Andrew K
AK
Department of Emergency Medicine, University of California, Irvine Medical Center, Orange, California 92868, USA.
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D004172:Diplopia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D018450:Disease Progression; D004636:Emergency Service, Hospital; D017809:Fatal Outcome; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008581:Meningitis / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D008875:Middle Aged; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed