title: Leptomeningeal metastases presenting exclusively with ocular disturbance in 34 patients: A tertiary care cancer hospital experience.
abstract: Leptomeningeal disease (LMD) represents disseminated intracranial metastatic disease that requires early detection and initiation of therapy. Patients with LMD typically present with a variety of neurologic problems, including ocular disturbances. However, little is reported on LMD presenting exclusively with ocular-related disturbances in the absence of any other central nervous system (CNS) dysfunction. Our goal was to describe the workup for ocular disturbances in the setting of known cancer diagnosis. Retrospective case study utilizing prospectively collected database at a tertiary cancer care center for all patients with diagnosis of LMD between 2001 and 2009. Main outcome was descriptive analysis of ocular findings by primary or admitting service with or without formal ophthalmology exam in workup for LMD. 34 patients demonstrated ocular disturbances without any other CNS manifestations. Our findings demonstrate that 71% of ocular disturbances were detected by the primary admitting services. Formal consultation with ophthalmology resulted in the detection of the remaining cases. The most common findings were cranial nerve deficits, papilledema, and optic disc or retinal infiltration by tumor. These findings supported a further work-up for CNS disease. Therefore, it is appropriate to refer cancer patients with visual complaints or findings on exam to ophthalmology to evaluate for evidence suggestive of LMD that may support a further work-up.
authors.affiliation: Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA; Department of Neurosurgery, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA. Electronic address: rrmayer@bcm.edu.
authors.forename: Rory Richard
authors.initials: RR
authors.lastname: Mayer
authors.affiliation: Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA. Electronic address: benjamin.frankfort@bcm.edu.
authors.forename: Benjamin Jay
authors.initials: BJ
authors.lastname: Frankfort
authors.affiliation: Department of Neurosurgery, University of Southern California, Los Angeles, CA, USA.
authors.forename: Ben A
authors.initials: BA
authors.lastname: Strickland
authors.affiliation: Department of Diagnostic Radiology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA. Electronic address: matthew.debnam@mdanderson.org.
authors.forename: James Matthew
authors.initials: JM
authors.lastname: Debnam
authors.affiliation: Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA; Department of Neurosurgery, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
authors.forename: Ian E
authors.initials: IE
authors.lastname: McCutcheon
authors.affiliation: Austin Brain Tumor Center, Texas Oncology/US Oncology Research, Austin, TX, USA. Electronic address: morris.groves@usoncology.com.
authors.forename: Morris D
authors.initials: MD
authors.lastname: Groves
authors.affiliation: Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA; Department of Neurosurgery, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA. Electronic address: jweinberg@mdanderson.org.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Weinberg
mesh_terms: D000328:Adult; D000368:Aged; D002173:Cancer Care Facilities; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D055756:Meningeal Carcinomatosis / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D063128:Tertiary Health Care / Q000379:methods; D014786:Vision Disorders / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy
keywords: Leptomeningeal disease; Metastatic disease; Ocular disturbance