CSF in carcinomatous meningitis

Q: The cerebrospinal fluid (CSF) pressure in leptomeningeal metastases is usually? (select one)

A) high

B) low

Answer: A

Brain is covered (from outside to inside) with three layers

• dura mater
• arachnoid mater
• pia mater

The arachnoid and the pia mater are collectively called leptomeninges. Whenever any tumor involves the leptomeninges, it is leptomeningeal metastases. It is also called meningeal carcinomatosis, carcinomatous meningitis, and neoplastic meningitis. 

In a patient with a history of tumor and clinical signs, a high opening pressure is almost always synonymous with leptomeningeal metastases. Other expected CSF findings are low glucose, high protein, lymphocytic pleocytosis, and positive cytology. Unfortunately, positive cytology is not always present.

#neurology

#oncology

#procedures

References:

1. Bönig L, Möhn N, Ahlbrecht J, Wurster U, Raab P, Puppe W, Sühs KW, Stangel M, Skripuletz T, Schwenkenbecher P. Leptomeningeal Metastasis: The Role of Cerebrospinal Fluid Diagnostics. Front Neurol. 2019 Aug 20;10:839. doi: 10.3389/fneur.2019.00839. PMID: 31481919; PMCID: PMC6710356.

2. Chamberlain MC. Leptomeningeal metastasis. Semin Neurol. 2010 Jul;30(3):236-44. doi: 10.1055/s-0030-1255220. Epub 2010 Jun 24. PMID: 20577930.