Ocular symptoms secondary to meningeal carcinomatosis in a patient with lung adenocarcinoma: a case report

BMC Ophthalmology

Case Report

Alfonso L Sabater¹  Elisa de Nova¹  Luis M Sadaba¹ 

[1] Department of Ophthalmology, Clínica Universidad de Navarra, Navarra, Apartado 4209, 31008, Pamplona, Spain;

关键词: Zoledronic Acid;    Brain Magnetic Resonance Imaging;    Ocular Symptom;    Spinal Magnetic Resonance Imaging;    Intrathecal Chemotherapy;   

DOI  :  10.1186/1471-2415-12-65

 received in 2012-07-24, accepted in 2012-12-12,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundMeningeal carcinomatosis (MC) is a rare complication associated with hematologic and solid tumors. MC develops when malignant cells gain access to the leptomeningeal space, producing several clinical symptoms. Loss of vision and ocular motility deficit are the most frequent ocular symptoms reported. Fundus examination usually appears normal, although optic nerve alterations like optic atrophy or papilledema have been described. MC diagnosis is usually completed by magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) analysis. Indicated treatment for MC usually involves intrathecal chemotherapy combined with radiotherapy, although survival rate is extremely low.Case presentationA 66-year old man with stage IV metastatic lung adenocarcinoma, presented to the Ophthalmology Department with a two-month history of double vision, soft headaches and dizziness episodes. The patient presented a best visual corrected acuity of 0.7 in his right eye and 0.8 in his left eye. Diplopia was corrected with 6-prism diopters base-out prism in right eye. Funduscopy showed a bilateral papilledema, juxtapapillary exudates and splinter hemorrhages. Brain MRI showed a diffuse leptomeningeal enhancement in cortical sulcus. Lumbar puncture was performed and cerebrospinal fluid (CSF) cytology revealed malignant cells compatible with a diagnosis of MC. Intrathecal chemotherapy was administered.ConclusionMC is a serious complication of systemic cancer patients, involving a poor prognosis. Early diagnosis is extremely important, although treatment is frequently aimed to reduce the symptoms and extend survival. Eye symptoms may be the chief complaint, so MC should be considered in any patient with vision loss or diplopia accompanied by neurologic symptoms and in the absence of an intraocular cause, especially in the context of systemic cancer.

【 授权许可】

Unknown   
© Sabater et al.; licensee BioMed Central Ltd. 2012. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.