Clinical Neurology and Neuroscience
Volume 1, Issue 2, May 2017, Pages: 34-37
Received: Jan. 24, 2017;
Accepted: Apr. 6, 2017;
Published: Apr. 30, 2017
Views 1399 Downloads 61
Selin Yetkinel, Department of Neurology, Agri State Hospital, Agri, Turkey
Basak Karakurum Goksel, Baskent University Faculty of Medicine, Department of Neurology, Adana Teaching and Medical Research Center, Adana, Turkey
Headache, the most common symptom of cerebral dysfunction caused by leptomeningeal carcinomatosis, may be the only symptom. The headache usually results from increased intracranial pressure. Brain metastasis of gastric cancer in particular is rarely encountered and leptomeningeal carcinomatosis (LMC) is even less common. Presentation with isolated headache is a very rare condition in patients with gastric carcinoma. This 48-year-old man was admitted to the neurology outpatient clinic with headache that was present for nearly one month. The pain was felt in entire head particularly in the occipital and neck regions. The nature of the pain was throbbing, which worsened in the morning while the patient was in supine position. His headache persisted for all day. There was no nausea and vomiting. Neurological examination was normal. Brain MRI (contrast-enhanced) demonstrated triventricular hydrocephaly with transependymal edema. MR angiography and venography were also normal. Lumbar puncture revealed high cerebrospinal fluid (CSF) pressure (320 cm H2O), normal biochemistry except for mildly elevated protein, and unremarkable microbiological and pathological examination five days, and fundus examination revealed papilledema. Abdominal tomography demonstrated a focal area of increased gastric wall thickening. Result of endoscopic examination was reported as giant ulcer. PET showed increased FDG uptake in the gastric antrum. Gastric biopsy revealed diffuse carcinoma. Ventriculo-peritoneal shunt was performed for hydrocephalus. His treatment continued at medical oncology department. We reported this case since clinical presentation with isolated headache in the patients with gastric carcinoma is a rare condition.
Basak Karakurum Goksel,
Ring Cell Gastric Cancer Presenting with Headache, Clinical Neurology and Neuroscience.
Vol. 1, No. 2,
2017, pp. 34-37.
Copyright © 2017 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/
) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Jayson GC, Howell A. Carcinomatous meningitis in solid tumours. Ann Oncol 1996; 7: 773-86.
Kim M. Intracranial involvement by metastatic advanced gastric carcinoma. J Neurooncol 1999; 43: 59-62.
Victor SH, Tuch P, Wang CCK. An unusual case of headache. Journal of Clinical Neuroscience 2003;10 (5):612-6.
Omuro AM1, Lallana EC, Bilsky MH, De Angelis LM. Ventriculoperitoneal shunt in patients with leptomeningeal metastasis. Neurology. 2005;10;64(9):1625-7.
Hyun JW, Jeong IH, Joung A, Cho HJ, Kim SH, Kim HJ. Leptomeningeal metastasis: Clinical experience of 519 cases. Eur J Cancer. 2016 Mar;56:107-14.
Choi E1, Lewis AL, Takei H, Ro JY. Leptomeningeal carcinomatosis as initial presentation in adenocarcinoma of lung with signet ring cell features: an autopsy case report. Int J Clin Exp Pathol. 2012;5(9):972-6.
Lee JL, Kang YK, Kim TW, et al. Leptomeningeal carcinomatosis in gastric cancer. J Neurooncol 2004; 66: 167-74.
Park KK, Yang SI, Seo KW, Kim YO, Yoon KY. A case of metastatic leptomeningeal carcinomatosis from early gastric carcinoma. World J Surg Oncol. 2012; 3;10:74.
Pavlidis N. The diagnostic and therapeutic management of leptomeningeal carcinomatosis. Ann Oncol 2004;15;285-291.
Wasserstrom WR, Glass JP, Posner JB. Diagnosis and treatment of leptomeningeal metastases from solid tumors: experience with 90 patients. Cancer. 1982 Feb 15;49(4):759-72.
Lisenko Y, Kumar AJ, Yao J, et al. Leptomeningeal carcinomatosis originating from gastric cancer. Am J Clin Oncol 2003; 26:165-70.
Glantz MJ, Cole BF, Glantz LK, Cobb J, Mills P, Lekos A, et al. Cerebrospinal fluid cytology in patients with cancer: Minimizing false-negative results. Cancer. 1998; 82:733–9.
Little JR, Dale AJ, Okazaki H. Meningeal carcinomatosis. Clinical manifestations. Arch Neuro 1974; 30: 138–143.
Olson ME, Chernik NL, Posner JB. Infiltration of the leptomeninges by systemic cancer. A clinical and pathologic study. Arch Neuro 1974; 30: 122–137).
Mack F, Baumert BG, Schäfer N, Hattingen E, Scheffler B, Herrlinger U, Glas M. Therapy of leptomeningeal metastasis in solid tumors. Cancer Treat Rev. 2016 Feb;43:83-91.
Roth P, Weller M. Management of neoplastic meningitis. Chin Clin Oncol. 2015 Jun;4(2):26.
Roguski M, Rughani A, Lin CT, Cushing DA, Florman JE, Wu JK. Survival following Ommaya reservoir placement for neoplastic meningitis. J Clin Neurosci. 2015 Sep;22(9):1467-72.
Chamberlain MC, Leptomeningeal metastasis. Curr Opin Neurol. 2009; 22(6):665-74.
Oh SY, Lee SJ, Lee J, et al. Gastric leptomeningeal carcinomatosis: multi-center retrospective analysis of 54 cases. World J Gastroenterol 2009; 15: 5086-90.
Hikima K, Nagayama M, Sato T, Inoue T, Nagai M. A Case of Meningeal Carcinomatosis and Small Cell Lung Carcinoma Effectively Treated Using a Multidisciplinary Approach. Gan To Kagaku Ryoho. 2017 Feb;44(2):153-155.
Zhao J, Liu J, Zhang Z, Wu M, Li J, Xiao G, Liao X, Liu Y. Experience of shunting surgery in treatment for meningeal carcinomatosis. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2017 Feb 28; 42(2):236-240.