Leptomeningeal invasion by systemic cancer was diagnosed clinically or pathologically in 50 patients over four years. All had neurological symptoms referable to tumor seeding the meninges. Clinical diagnosis was suggested by the simultaneous occurrence of symptoms or signs in more than one area of the neuraxis. Neurological signs were much more prominent than symptoms. Clinical diagnosis was confirmed by the presence of malignant cells in the cerebrospinal fluid (CSF), multiple examinations of CSF sometimes being necessary. The disease was usually inexorably progressive, but in some instances responded to radiation and intrathecal chemotherapy. At autopsy there were leptomeningeal thickening, occasionally tumor nodules along the cauda equina and, in some patients, hydrocephalus. Sometimes, despite prominent clinical signs, there were no gross pathologic abnormalities. Microscopic changes were multifocal rather than diffuse, making extensive sampling of leptomeninges necessary to establish the pathologic diagnosis.
Olson ME, Chernik NL, Posner JB. Infiltration of the Leptomeninges by Systemic CancerA Clinical and Pathologic Study. Arch Neurol. 1974;30(2):122–137. doi:10.1001/archneur.1974.00490320010002
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