Leptomeningeal disease - 1267494

Tue, 12/09/2014 - 10:48

Can Leptomeningeal Disease be confirmed without a spinal tab or could the enhancement on the MRI indicate other issues too.
My father was diagnosed with Leptomeningeal Disease due to enhancement on the MRI. The doctor said the MRI actually does not look that bad but they are basing the diagnose alot on the condition of the patient. He had brain surgery for matastatic lung cancer. He was doing quite well after surgery besides the confusion that he was experiencing. With time his confusion got worse and his averall condition was deteriorating. The MRI and PET scans though were all ok.
The last MRI unfortunately showed some enhancement and in combination with his bad physical and cognitive condition the doctor assumes it is Leptomeningeal disease.
Yesterday he was admitted to the hospital for a feeding tube because he is refusing to eat for several weeks now. Upon examination they found that his sodium level was abnormally high and they think that alot of his bad mental state is related to the high sodium level.
My question is, can the enhancement on the MRI point to other issues or due we accept the assumption that this is Leptomeningeal disease without doing additional testing.

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Hi Racheli,

Usually LMC produces a wider range of issues than just cognitive, such as headaches, double vision and focal weakness/instability. It is possible to test the cerebrospinal fluid for cancer cells via a spinal tap, but it is a painful procedure that often does not produce a definitive diagnosis.

Whatever the cause, I am sorry that you and your family needs to deal with this.

Forum moderator

Dr West

Leptomeningeal carcinomatosis (LMC) is often not confirmed because even a lumbar puncture (spinal tap) doesn't always show the cancer cells. We use a combination of the imaging findings, the clinical symptoms, and the lumbar puncture results, if done. Sometimes there are no cancer cells in the spinal fluid even when there really is LMC (it may take multiple taps to get cancer cells), so you can have a diagnosis of LMC without having all of the components in perfect alignment. Because there is really no treatment with any consistent efficacy for LMC in lung cancer, there isn't often a clear critical need to chase down the diagnosis.

I would say, however, that seeing a marked clinical decline, including with confusion and a lost ability to manage independently, is definitely worrisome for LMC -- it's very much the picture we tend to see. Any time a patient is demonstrating a marked overall decline that isn't readily explained by the imaging, LMC is high on the list of possibilities. And if the brain imaging shows findings consistent with LMC, it's even more likely, I'm sorry to say.

Good luck.

-Dr. West



I am very sorry to hear about your father and the presumption that he has LMC. LMC is often difficult to diagnose and generally beyond general cognitive distress there are a host of other symptoms such as difficulty walking, swallowing, speech, vision, and memory that often come to play, it is likely the doctors are correct. In my wife's case she had bad headaches prior to the above symptoms and a spinal puncture confirmed the diagnosis.

If it is indeed LMC I suggest that you seek additional help with caregiving and begin looking into hospice. What a rotten thing to have to deal with during the holidays. I wish you and your family good luck and peace in the coming days.