Meningeal and brainstem infiltration by a malignant mesothelioma.
Malignant mesothelioma is an uncommon neoplasia which primarily involves the pleura or peritoneum. Central nervous system involvement is rare. A rare presentation of metastatic pleural mesothelioma, which had infiltrated the meninges and brainstem, is described. The patient presented with diplopia following a 2-week history of malaise, myalgia, mild headache and diarrhoea. Clinical examination found global areflexia, cerebellar ataxia and bilateral sixth nerve palsies. Differential diagnoses included the Miller-Fisher variant of Guillain-Barre syndrome, malignant meningitis and infectious meningitis. The patient was treated with immunoglobulins, plasmaphoresis and corticosteroids; however, he deteriorated and died 31 days after admission. Retrospective examination of the MRI of the brain found diffuse low attenuation changes within the pons and cerebral peduncles. Postmortem examination favoured a diagnosis of an early sarcomatoid malignant mesothelioma of pleural origin with leptomeningeal metastatic deposits.
Department of Anaesthetics, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK. kim.wild@doctors.org.uk
Kim
K
Wild
Prasanna
P
Sankaran
Anita
A
Nagy
James
J
Sington
D000368:Aged; D020295:Brain Stem Neoplasms / Q000175:diagnosis / Q000556:secondary*; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000556:secondary*; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis / Q000556:secondary*; D008654:Mesothelioma / Q000175:diagnosis / Q000556:secondary*; D000086002:Mesothelioma, Malignant; D010997:Pleural Neoplasms / Q000473:pathology*