Papilledema: Could It Be an Important Clinical Sign of Leptomeningeal Metastasis?

Abstract

Aim:Leptomeningeal metastasis (LM), which can be seen in all types of cancer, is a rare condition with poor prognosis. Diagnosis and treatment are important components of the management of the disease. We aimed to reveal clues for early diagnosis by examining the clinical and laboratory features of LM.Methods:Sixteen patients who received the diagnosis of LM between 2018 and 2020 were included in the study retrospectively. The cerebrospinal fluid (CSF) samples and cranial magnetic resonance imaging of the patients were examined. In addition, the patients were divided into two groups according to the presence of papilledema.Results:The mean age of the patients was 49 (19-73) and 37.5% were women. The most common histological tumor type was adenocarcinoma. The most common clinical finding was multiple cranial neuropathy. The mean time to the diagnosis of LM was 20 months. Eleven of the 16 patients had solid tumors, five had hematological malignancies. Nine patients had papilledema. Headache was significantly more common in the group with papilledema (p=0.01). The average lifespan after the diagnosis of LM was 8 months (1-48 months). Malignant cells were detected in the CSF cytology of four patients (30%).Conclusion:LM is a condition with poor prognosis and difficult to diagnose in oncology patients, despite all tests being performed under appropriate conditions. Presence of papilledema is thought to contribute to the diagnosis since the evaluation of intracranial in LM patients is a non-invasive evaluation method.

Keywords

• leptomeningeal metastasis
• papilledema
• headache