Papilloedema and lymphocytic meningitis in a 68 year old man

A Case of Leptomeningeal Carcinomatosis Manifesting With Vertigo in the Setting of Intracranial Hypertension

Leptomeningeal carcinomatosis (LMC) is a rare condition where malignant cells infiltrate the leptomeninges of the central nervous system. We present a case of a 51-year-old male with stage IV adenocarcinoma of the lung who developed recurrent vertigo. The patient initially received a diagnosis of peripheral vertigo, but his symptoms worsened over time and were associated with headache, vomiting, and one episode of seizure. Upon readmission, based on his normal neuroimaging results, normal CSF examination with elevated opening pressure, and papilledema on fundoscopic examination, a diagnosis of pseudotumor cerebri was made. The result of CSF cytology revealed the presence of malignant cells confirming the presence of LMC. This case highlights the importance of considering LMC as a potential cause for unusual neurological symptoms in patients with advanced malignancy, particularly when other conditions like pseudotumor cerebri could obscure its presentation. It is crucial to rule out malignancy through CSF cytology in patients presenting with vertigo and/or other vestibulocochlear symptoms before making an alternative diagnosis that could present similarly.

Malignant meningitis presenting as pseudotumor cerebri

Malignant leptomeningitis can present as the clinical syndrome of pseudotumor cerebri due to infiltration of arachnoid villi in the superior sagittal sinus. We show that malignant pachymeningitis can also present with pseudotumor cerebri, likely due to cerebral venous hypertension from transverse sinus compression. We present 3 cases of pseudotumor cerebri due to pachymeningeal or leptomeningeal metastases and discuss the mechanism of intracranial hypertension in such cases, its diagnosis and treatment.

[Primary lymphoma of the prostate: report of a clinico-pathological case and review of the literature]

Lymphoma involving the prostate is rare, wether presenting as primary extranodal lymphoma or as a secondary spread to the prostate from other sites. There are less than 100 cases reported in the literature and accounts for 0.09-0.1%. The clinical presentation can be attributed to nodular hyperplasia or prostatic carcinoma. Criteria for primary prostatic lymphoma include: 1) tumor limited to the prostate and adjacent soft tissues. 2) the absence of lymph node involvement. 3) a lymphoma free interval of at least 1 month. The evolution is rapid and the prognosis remains poor regardless of the patient age, histologic type, treatment, or clinical stage of disease at presentation. We report a case of a 65 years old male in which the incidental diagnosis of lymphoma of the prostate was performed in the adenomectomy. The clinico-pathological criteria and the histogenesis of this entity are described.