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Neuroborreliosis Mimicking Leptomeningeal Carcinomatosis in a Patient With Breast Cancer: A Case Report.

Fischer S, Weber J, Senn-Schönenberger I, Cerny T, Hundsberger T - J Investig Med High Impact Case Rep (2014)

Bottom Line: Assessment of cerebrospinal fluid found no malignant cells but investigation for infectious diseases established the diagnosis of neuroborreliosis.After completion of treatment, follow-up MRI scans found complete regression of meningeal enhancement.Cerebrospinal fluid analysis is strongly recommended due to low specificity of MRI images in this regard.

View Article: PubMed Central - PubMed

Affiliation: Cantonal Hospital, St Gallen, Switzerland.

ABSTRACT
Leptomeningeal carcinomatosis is a serious complication of advanced cancer. Various clinical manifestations may present, such as headache, nausea, seizures, cranial neuropathies. In this article, we report the case of a 65-year-old woman with metastatic breast cancer who was admitted to hospital suffering from facial palsy, which was suspected to be caused by leptomeningeal tumor infiltration. Magnetic resonance imaging (MRI) scans of the head and spine showed meningeal enhancement of the facial nerve, conus medullaris, and fibers of the cauda equina, which were radiologically interpreted as leptomeningeal carcinomatosis. Assessment of cerebrospinal fluid found no malignant cells but investigation for infectious diseases established the diagnosis of neuroborreliosis. Antibiotic treatment with doxycycline was performed. After completion of treatment, follow-up MRI scans found complete regression of meningeal enhancement. Several months later, the patient is still in good condition and without neurological symptoms. Hence, initial diagnosis of leptomeningeal carcinomatosis was rejected. This case report should alert oncologists to carefully rule out infectious diseases before leptomeningeal carcinomatosis is diagnosed. Cerebrospinal fluid analysis is strongly recommended due to low specificity of MRI images in this regard.

No MeSH data available.


Related in: MedlinePlus

MRI head axial, FLAIR (August 2013): multiple unspecific gliosis spots in the white matter, seen bihemispheric, which can also occur due to neuroborreliosis, exemplarily 2 frontal lesions shown here (arrows).
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fig3-2324709614529417: MRI head axial, FLAIR (August 2013): multiple unspecific gliosis spots in the white matter, seen bihemispheric, which can also occur due to neuroborreliosis, exemplarily 2 frontal lesions shown here (arrows).

Mentions: Follow-up MRI scans of head and spine 6 weeks after initial presentation and after termination of antibiotic treatment demonstrated complete regression of the meningeal enhancement of both facial nerves and of the spinal cord (Figures 1B and 2B). Therefore, we abandoned the diagnosis of a leptomeningeal carcinomatosis and concluded that all former neurological and MR tomographic abnormalities were due to a neuroborreliosis (see also Figure 3).


Neuroborreliosis Mimicking Leptomeningeal Carcinomatosis in a Patient With Breast Cancer: A Case Report.

Fischer S, Weber J, Senn-Schönenberger I, Cerny T, Hundsberger T - J Investig Med High Impact Case Rep (2014)

MRI head axial, FLAIR (August 2013): multiple unspecific gliosis spots in the white matter, seen bihemispheric, which can also occur due to neuroborreliosis, exemplarily 2 frontal lesions shown here (arrows).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4528861&req=5

fig3-2324709614529417: MRI head axial, FLAIR (August 2013): multiple unspecific gliosis spots in the white matter, seen bihemispheric, which can also occur due to neuroborreliosis, exemplarily 2 frontal lesions shown here (arrows).
Mentions: Follow-up MRI scans of head and spine 6 weeks after initial presentation and after termination of antibiotic treatment demonstrated complete regression of the meningeal enhancement of both facial nerves and of the spinal cord (Figures 1B and 2B). Therefore, we abandoned the diagnosis of a leptomeningeal carcinomatosis and concluded that all former neurological and MR tomographic abnormalities were due to a neuroborreliosis (see also Figure 3).

Bottom Line: Assessment of cerebrospinal fluid found no malignant cells but investigation for infectious diseases established the diagnosis of neuroborreliosis.After completion of treatment, follow-up MRI scans found complete regression of meningeal enhancement.Cerebrospinal fluid analysis is strongly recommended due to low specificity of MRI images in this regard.

View Article: PubMed Central - PubMed

Affiliation: Cantonal Hospital, St Gallen, Switzerland.

ABSTRACT
Leptomeningeal carcinomatosis is a serious complication of advanced cancer. Various clinical manifestations may present, such as headache, nausea, seizures, cranial neuropathies. In this article, we report the case of a 65-year-old woman with metastatic breast cancer who was admitted to hospital suffering from facial palsy, which was suspected to be caused by leptomeningeal tumor infiltration. Magnetic resonance imaging (MRI) scans of the head and spine showed meningeal enhancement of the facial nerve, conus medullaris, and fibers of the cauda equina, which were radiologically interpreted as leptomeningeal carcinomatosis. Assessment of cerebrospinal fluid found no malignant cells but investigation for infectious diseases established the diagnosis of neuroborreliosis. Antibiotic treatment with doxycycline was performed. After completion of treatment, follow-up MRI scans found complete regression of meningeal enhancement. Several months later, the patient is still in good condition and without neurological symptoms. Hence, initial diagnosis of leptomeningeal carcinomatosis was rejected. This case report should alert oncologists to carefully rule out infectious diseases before leptomeningeal carcinomatosis is diagnosed. Cerebrospinal fluid analysis is strongly recommended due to low specificity of MRI images in this regard.

No MeSH data available.


Related in: MedlinePlus