Meningitis as a Hidden Cause of Neurological Deterioration in Patients With Known Brain Metastases: A Report of Two Cases

Ioannis Vrettos, Panagiota Voukelatou, Stavros Fokas, Athina Bitsikokou, Athanasios Didaskalou, Andreas Kalliakmanis

Abstract


When a patient with known brain metastases presents to the emergency department with neurological deterioration, an overt diagnosis exists. However, alternative diagnoses should also be considered in the appropriate clinical context. A correct diagnosis is critical for the appropriate treatment, especially in cases, in which a reversible cause of illness exists. In this report, we describe two cases of cancer patients with known brain metastases in whom the neurological deterioration was due to carcinomatous meningitis and viral menigitis, respectively. A lumbar puncture was performed based on the fact that neurological deterioration was in contrast with the absence of new findings in brain CT scans. As it is emphasized by these two cases, patients with brain metastases, unchanged at CT imaging, and recent neurological deterioration must undergo lumbar puncture before their symptoms are considered a progression of their already existing brain metastases. In some cases, the deterioration might be due to a potentially reversible illness or due to an illness requiring specific treatment.




J Med Cases. 2016;7(11):475-477
doi: http://dx.doi.org/10.14740/jmc2631w


Keywords


Cancer; Brain metastases; Fever; Altered mental status; Headache; Meningitis

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