Bronchogenic Carcinoma Presenting as Carcinomatous Meningitis

Neoplastic meningitis, also known as carcinomatous meningitis, reflects the metastatic infiltration of the cerebrospinal fluid (CSF) and leptomeninges (pia and arachnoid) by cancer. It is the is the third most common cause of central nervous system (CNS) metastases after brain metastases and epidural spinal cord compression [1]. Leptomeningeal metastasis (LMM) is a devastating complication of malignancy, affecting patients with both solid tumors and hematologic malignancies. The prognosis of LMM is poor, with patients reported to survive for 1-6 months from the time of the diagnosis [2]. The solid tumors that most frequently give rise to LMM are breast carcinoma, melanoma, and lung carcinoma [3]. The incidence of neoplastic meningitis in non-small-cell lung cancer (NSCLC) is approximately 1% to 3%. Neoplastic meningitis is diagnosed in most patients with active systemic disease (70% overall). However, rarely it may be the first manifestation of the cancer (5%) [4].