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Images in Neurology
June 2006

Leptomeningeal Carcinomatosis: Cerebrospinal Fluid Findings

Arch Neurol. 2006;63(6):910. doi:10.1001/archneur.63.6.910

A 62-year-old man with microcellular lung cancer (T3N1M1, stage IV) diagnosed 5 months prior sought care for sudden right-sided limb weakness and speech disturbance. Neurologic examination revealed hemiparesis of the right limbs and motor dysphasia. In the next few days, he developed left external ophthalmoplegia with left peripheral facial palsy, left unilateral paralysis of the soft palate, and cognitive impairment, including lethargy and confusion. The findings from contrast-enhanced brain computed tomographic scans performed on 2 occasions were normal. Cerebrospinal fluid examination revealed 92 cells, 81 of which were poorly differentiated malignant cells (Figure 1 and Figure 2), a low glucose level of 2.10 mmol/L (37.8 mg/dL), protein level of 1.69 g/L, and elevated lactate dehydrogenase levels (301 U/L). Magnetic resonance imaging was not performed because the patient died as a result of complications (sepsis and pneumonia).

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