Kartsinomatozny meningitis — defeat of brain covers metastasises of a cancer tumor. Occurs at a dissemination of tumor cells, has melkoochagovy diffusion character. It is clinically shown by meningitis symptomatology with dysfunction of cranial nerves, disorder of consciousness. Kartsinomatozny meningitis is diagnosed by results of the analysis of tserebrospinalny liquid, given to cerebral MRT. Treatment is palliative: symptomatic (antiemetic, diuretics, antikonvulsant, glucocorticosteroids), chemotherapeutic (methotrexate), beam.
The name "kartsinomatoz" designates carcinoma metastasis. However in Russian-speaking literature on neurology and oncology the term "kartsinomatozny meningitis" it is accepted to designate all metastatic cancer defeats of cerebral covers. Synonymous names are neoplastic meningitis, leptomeningealny metastasises, cerebral covers. Metastasises in covers of a brain are observed in 5-8% of cases of all malignant tumors. Most often in covers spread melanomas and bronkhogenny carcinomas. At 50% of patients the demonstration of meningitis acts as the first clinical manifestation of a dissemination of oncological process. In some cases kartsinomatozny meningitis advances even emergence of the clinical symptomatology caused by primary cancer tumor.
Reasons of kartsinomatozny meningitis
Malignant new growths, various on localization and histologic type, act as a source of metastasises. Primary center more often is lung cancer, a bronchial tube carcinoma, a breast cancer, a melanoma, is more rare — stomach cancer, a gepatotsellyulyarny carcinoma, kidney cancer. Tumor cells of primary education get to cerebral covers with blood current. Usually there is a multifocal defeat having widespread character or limited by a certain site. In half of cases kartsinomatozny meningitis is combined with simultaneous formation of metastasises in brain substance, at 65% of cancer patients — with metastasis in internals.
The cancer cells which got to cerebral covers breed in fabrics of covers, leptomeningealny space. The irritation of covers causes emergence of a classical meningealny syndrome. Formation of the metastatic centers in the podobolochechny space filled with tserebrospinalny liquid (likvor) leads to violation of a likvorotsirkulyation, there is intra cranial hypertensia. As a result of difficulty of a likvoroottok hydrocephaly is formed. The accruing increase in intra cranial pressure causes development of zhizneugrozhayushchy complications: hypostasis of cerebral substance, dislocation of brain structures.
Symptoms of kartsinomatozny meningitis
In typical cases there is a gradual aggravation of neurologic symptomatology. Basic clinical manifestations: headache, nausea, dysfunction of craniocereberal nerves, disorders of consciousness, epileptic paroxysms, ataxy. The headache is intensive, is followed by the vomiting which is not depending on meal, not giving relief to the patient. Glazodvigatelny violations, paresis of a facial nerve, swallowing difficulty, change of a voice (dysphonia) and speeches (dizartriya) are possible.
Passing psychomotor excitement is replaced by slackness, drowsiness. At the accompanying intracerebral defeat there is the corresponding focal symptomatology. The Meningealny syndrome besides an intensive tsefalgiya is shown by a giperesteziya (hypersensibility to sounds, light, touches), tonic phenomena: the rigidnost (tonic tension) of occipital muscles compelled by the patient's pose with the extremities bent and given to a trunk, the head which is thrown back back.
The progressing kartsinomatozny process causes heavy violations of consciousness up to a coma. The accruing intrakranialny hypertensia, hydrocephaly are complicated by development of hypostasis of a brain. The mass effect is resulted by the shift of cerebral structures in the direction of a big occipital opening. There is a danger of a sdavleniye of a cerebral trunk, the vital regulatory centers located in it: cardiovascular, respiratory. The last complication often is a cause of death of the patient.
To diagnose kartsinomatozny meningitis not easy as its symptomatology is similar to meningitis of other etiology. The clinic imitating obolochechny kartsinomatozny process arises at cancer patients owing to development of a paraneoplastic syndrome, dismetabolichesky violations caused by cancer damage of internals. In some cases the neurologic symptomatology acts as a complication of chemotherapeutic and radiological treatment of primary tumoral center. Therefore the diagnosis cannot be established by the neurologist only on clinical signs. The next additional researches are necessary:
- Brain MRT. Diagnoses hydrocephaly, with mass effect — the shift of brain structures. Defines increase in density of covers, existence in them of the small centers. MRT with contrasting allowing to reveal accumulation of contrast in obolochechny fabrics, subarakhnoidalny spaces is more informative.
- Lyumbalny puncture. It is carried out for a likvor fence only after an exception of hypostasis and dislocation according to MRT. The research of tserebrospinalny liquid finds increase in concentration of protein without existence of inflammatory changes. Identification of cancer cells at the first puncture reaches 45-50%. In case of negative result the repeated punctures helping to define presence of malignant cages still at 40% of patients are carried out.
Lack of a possibility of tomographic neurovisualization dictates need of carrying out an ekhoentsefalografiya. Inspection does not allow to establish to a topic and defeat genesis, but gives the chance to estimate degree of intra cranial hypertensia, to reveal a dislocation syndrome. It is necessary to differentiate kartsinomatozny meningitis with an obolochechny form of a neuroleukosis, infectious meningitis, meningoentsefalita.
Treatment of kartsinomatozny meningitis
As meningealny metastasises are result of a cancer dissemination, only palliative therapy is possible. It consists in treatment by cytostatic himiopreparata, radiotheraphy and a combination of these techniques.
- Chemotherapy. As choice medicine well proved a methotrexate. In parallel with system chemotherapy the local introduction a cytostatics which is carried out endolyumbalno or by a puncture of ventricles can be carried out.
- Radiotheraphy. Radiation of all brain is necessary. The recommended total dose of 30-40 Gr. Treatment is carried out by separate procedures within 2-4 weeks.
Taking into account clinical manifestations symptomatic therapy is performed. For knocking over of vomiting antiemetic medicines, for decrease in intra cranial pressure — diuretic are used, prevention of hypostasis of a brain is performed by a combination diuretic with corticosteroids. The convulsive syndrome is the indication to purpose of antikonvulsant, at psychomotor excitement introduction of sedative medicines is necessary.
Forecast and prevention
In the absence of therapy kartsinomatozny meningitis within two months becomes a cause of death of the patient. Correct palliative treatment is capable to lead to temporary partial remission, to prolong life of patients on average up to 6 months. Longevity since diagnosing of a disease was observed more than 12 months only at 15% of patients. 50% of lethal outcomes are connected with defeat of TsNS, 50% – with pathology of internals. Great preventive value has an onkonastorozhennost of patients and doctors as it is possible to prevent kartsinomatozny process by timely identification and radical treatment of primary new growth.