title: Leptomeningeal carcinomatosis from oesophageal cancer, presenting as meningitis.
abstract: A 47-year-old woman presented with headache, neck pain, dizziness, nausea and vomiting for 4-5 days. She also had a history of weight loss and difficulty in swallowing. On physical examination, she had nuchal rigidity with a positive Kernig's sign. Cerebrospinal fluid analysis revealed mild pleocytosis but some atypical cells were also noted. Cytopathological analysis of the atypical cells showed high nuclear/cytoplasmic ratios and eccentric nuclei with prominent nucleoli, consistent with malignancy. A CT scan of the head and neck showed multiple lytic lesions involving the left calvarium, and diffuse thickening and enhancement of meninges over the left cerebral area. Extensive osteolytic lesions were also noted on the vertebral bodies, pedicles and lamina, at multiple levels of the cervical spine. An endoscopy revealed a mass at the gastro-oesophageal junction, and biopsy confirmed moderately differentiated adenocarcinoma of the oesophagus. The patient was started on chemotherapy along with radiation therapy.
authors.affiliation: Texas Tech University, Amarillo, Texas, USA.
authors.forename: Mashrafi
authors.initials: M
authors.lastname: Ahmed
authors.affiliation: Texas Tech University, Amarillo, Texas, USA.
authors.forename: Tahmina
authors.initials: T
authors.lastname: Begum
authors.affiliation: Texas Tech University, Amarillo, Texas, USA.
authors.forename: Abdel Rahman
authors.initials: AR
authors.lastname: Omer
authors.affiliation: Texas Tech University, Amarillo, Texas, USA.
authors.forename: Ishtiaque Amin
authors.initials: IA
authors.lastname: Khan
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000556:secondary*; D004938:Esophageal Neoplasms / Q000175:diagnosis*; D005260:Female; D006801:Humans; D055756:Meningeal Carcinomatosis / Q000134:cerebrospinal fluid / Q000556:secondary*; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure