Diagnosis

See page 475

Diagnosis suggested by chest X-ray - pulmonary infiltrations,

CT/MR evidence of meningeal enhancement and associated hydrocephalus CSF abnormalities lymphocytosis, low glucose and high protein with appropriate staining, culture and agglutination/complement-fixation tests.

Specific features Treatment

Clinical features similar to tuberculous meningitis.

Amphotericin B

fluorocytosine or fluconazole

Carcinomatous meningitis -lung/breast/ gastrointestinal tract Leukaemia/ lymphoma Glioma

Medulloblastoma Melanoma.

Evidence of primary neoplasm.

Back pain/

Consider

CT or MR evidence of

radicular

irradiation

meningeal enhancement

involvement

followed by

CSF

common.

intrathecal

Malignant cells seen in fresh

Hydrocephalus

methotrexate or

centrifuged filtered sample.

in 30%

monoclonal

Tumour markers:

targeting (see

- carcinoembryonic antigen

page 305).

(CEA)

Leukaemia/

- P-microglobulin

lymphoma

Meningeal biopsy rarely

requires

necessary but diagnostic

specialist

advice

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