Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

A case of leptomeningeal melanomatosis presenting with right abducens nerve palsy

Yuriko Nakaoku, M.D. 1), Gaku Murakami, M.D., Ph.D. 1), Yasuko Fujimoto, M.D., Ph.D. 2), Tomoyuki Shirase, M.D., Ph.D. 3), Rinpei Imamine, M.D. 4), Takahiro Mitsueda-Ono, M.D., Ph.D. 1) and Masaru Matsui, M.D., Ph.D. 1)

1)Department of Neurology, Otsu Red-Cross Hospital
2)Department of Otorhinolaryngology, Otsu Red-Cross Hospital
3)Department of Pathology, Otsu Red-Cross Hospital
4)Department of Radiology, Otsu Red-Cross Hospital

A 39 year-old man was admitted to this hospital because of severe headache and vomiting. He had been suffering from lumbago about one month previously, and diplopia ten days previously. The neurological examination revealed disturbance of right eye abduction, no nuchal rigidity. The cerebrospinal fluid (CSF) at the time of admission included erythrocytes (1,490/μl), white blood cell (62/μl) and increased level of protein (531 mg/dl), but no malignant cells were detected. He was treated as meningitis. Cranial magnetic resonance imaging (MRI) demonstrated heterogeneous intensity lesion in the left maxillary sinus and gadolinium enhancement of diffuse meninges and cranial nerves. Spine MRI showed gadolinium enhancement of lumbar spinal meninges and the cauda equina. Biopsy of the lesion in the left maxillary sinus was performed. The pathological findings demonstrated malignant melanoma. Because malignant cells were also observed in CSF, we diagnosed this case as leptomeningeal melanomatosis. Leptomeningeal carcinomatosis should be suspected when headache accompanied with pleomorphic clinical manifestations.
Full Text of this Article in Japanese PDF (7487K)

(CLINICA NEUROL, 54: 675|678, 2014)
key words: malignant melanoma, CSF cytology, leptomeningeal carcinomatosis, carcinomatous meningitis, abducens nerve palsy

(Received: 13-Dec-13)