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Paper 1
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
A 40 year old female with a background of invasive ductal breast carcinoma and mastectomy presents with headache and diplopia. An MRI brain is performed. The radiologist’s report states that the appearances are suggestive of leptomeningeal carcinomatosis.
Headache associated with central nervous system infection
Published in Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby, Headache in Clinical Practice, 2018
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby
Noninfectious etiologies of the aseptic meningitis syndrome include sarcoidosis, leptomeningeal carcinomatosis, systemic lupus erythematosus, Wegener’s granulomatosis, Behcet’s disease, and medications. Aseptic meningitis, characterized by headache, meningismus, and a CSF lymphocytic pleocytosis, may be a recurrent problem in patients who have neurosarcoidosis.48 Headache is the most frequent complaint in leptomeningeal carcinomatosis and is often associated with nausea, vomiting, and lightheadedness. Neck pain and stiffness are often present, although the meningismus is much less severe than that seen in purulent meningitis patients.49 The presenting symptoms in Wegener’s granulomatosis are typically cough, chest pain, hemoptysis, epistaxis, purulent nasal discharge, and sinus pain.
Development of palliative medicine in the United Kingdom and Ireland
Published in Eduardo Bruera, Irene Higginson, Charles F von Gunten, Tatsuya Morita, Textbook of Palliative Medicine and Supportive Care, 2015
Based on clinical and radiographic grounds, leptomeningeal carcinomatosis must also be considered in the diagnostic evaluation. Leptomeningeal carcinomatosis occurs more commonly than expected. For example, only half of breast cancer patients with leptomeningeal carcinomatosis will be diagnosed before death. Â 80,85,98,104,111 Radiation therapy is indicated in localized regions of nodular leptomeningeal involvement. Â 111
The impact of preoperative MRI-based apparent diffusion coefficients on local recurrence and outcome in patients with cerebral metastases
Published in British Journal of Neurosurgery, 2023
Julia Steinmann, Marion Rapp, Hosai Sadat, Franziska Staub-Bartelt, Bernd Turowski, Hans-Jakob Steiger, Daniel Hänggi, Michael Sabel, Marcel A. Kamp
Epidemiological data, data regarding tumour location, and primary tumour as well as pre- and postoperative images were collected from charts and electronic records. Patients were followed from the time of surgery until at least one year or first recurrence. Local recurrence was defined as a tumour recurrence or progression within or at the border of the resection cavity. Distant recurrence was defined as appearance of new metastases distant to the site of the resected metastasis. Leptomeningeal carcinomatosis was diagnosed by cranial MRI as diffuse enhancement of meninges or by lumbar puncture and confirmation of malignant tumour cells in the cerebrospinal fluid (CSF). Progression free survival (PFS) was defined as time between surgery and diagnosis of recurrence. Overall survival (OAS) was defined as time between surgery and date of death.
SOD1-targeting therapies for neurodegenerative diseases: a review of current findings and future potential
Published in Expert Opinion on Orphan Drugs, 2020
John P. Franklin, Mimoun Azzouz, Pamela J. Shaw
A downside to intrathecal ASO therapy for CNS disease is the need for repeated LPs at frequent intervals for dosing, which is a fairly unique and understudied clinical scenario. In idiopathic intracranial hypertension, patients may require repeated LPs to relieve CSF pressure and tend to feel negatively about this: they demonstrate a high level of anxiety regarding future LPs and frequently report LP-related side effects [99]. While LP-related side effects were observed in most patients enrolled in the phase I/II Tofersen study, these patients anecdotally tolerate LPs significantly better than the general population and experience only mild symptoms of headache and back pain following each procedure. This may possibly be because the intrathecal administration of the study drug in artificial CSF replenishes the CSF removed for analysis, thereby mitigating excessive changes in CSF pressure. Alternatively, the motivation engendered by the poor prognosis of the untreated SOD1-related ALS may promote better pain tolerance. Intrathecal pumps and reservoirs are technologically advanced and used widely in other conditions [100,101]. These technologies may provide a better-tolerated long-term alternative to repeated lumbar punctures for repeated ASO administration in CNS disease. Furthermore, in leptomeningeal carcinomatosis, where maintaining high CNS concentrations of chemotherapy is crucial, intrathecal delivery of chemotherapy via a surgical reservoir was found to be superior to serial lumbar puncture [100]. However, the downsides of potentially risky surgery may outweigh the benefit of improved tolerability, convenience and potentially superior pharmacokinetic properties in ALS patients and will require careful evaluation.
Papilloedema from Dural Venous Sinus Compression by Meningiomas
Published in Neuro-Ophthalmology, 2019
Alexander J. P. W. Hartmann, Michelle W. Latting, Michael S. Lee, Mark L. Moster, Amit M. Saindane, Nancy J. Newman, Valérie Biousse
We reviewed the medical records of the neuro-ophthalmology services at three tertiary care hospitals to identify patients with isolated intracranial hypertension and papilloedema who were found to have a solid intracranial mass suggestive of meningioma involving one or more DVS. We included cases with histologically proven meningiomas, as well as patients with a diagnosis of meningioma made radiologically. We excluded cases with diffuse leptomeningeal carcinomatosis. We also excluded patients in whom the diagnosis of intracranial mass was made because of focal neurologic symptoms or seizures.