Diffuse leptomeningeal infiltration by neoplastic cells is a well-recognized manifestation of malignant tumors. The usual clinical presentation is subacute or chronic meningitis with multifocal cranial and spinal nerve root symptoms and a variable degree of encephalopathy. We describe two patients with carcinomatous and leukemic meningitis mimicking Miller-Fisher syndrome.1
Report of Cases.
—A 73-year-old woman underwent a gastrectomy for cancer in July 1993. Six months later, she was admitted for diplopia, unsteadiness, and intermittent occipital headache that had started 3 days before. Neurologic examination disclosed bilateral abducens nerve paralysis, severe ataxia, and global areflexia. An electroencephalogram and a computed tomographic scan of the brain were normal. Cerebrospinal fluid (CSF) examination showed elevated proteins (0.66 g/L) with 1 cell per milliliter, and a low glucose level (0.34 g/L). Cytologic examination of the CSF disclosed adenocarcinomatous cells. Despite chemotherapy, the patient's condition became worse with rapid deterioration and death 20
Guarino M, Stracciari A, Cirignotta F, et al. Neoplastic Meningitis Presenting With Ophthalmoplegia, Ataxia, and Areflexia (Miller-Fisher Syndrome). Arch Neurol. 1995;52(5):443–444. doi:10.1001/archneur.1995.00540290021008
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