Bilateral Optic Neuropathy as Initial Manifestation of Meningeal Carcinomatosis in Non-Small-Cell Lung Cancer
Mastorodimos V, Mala A, Tsilimbaris M, Papadaki E, and Mitsias P. Bilateral Optic Neuropathy as Initial Manifestation of Meningeal Carcinomatosis in Non-Small-Cell Lung Cancer. Eur J Neurol 2019; 26:725.
Eur J Neurol
Background and aims: Meningeal carcinomatosis (MC) is a dreadful complication of hematologic and solid malignancies, usually associated with disseminated disease. It is very uncommon to encounter MC as the initial manifestation of systemic cancer Results: A 58-year-old woman, heavy smoker, with history of seronegative rheumatoid arthritis, untreated for the last two years, presented with deteriorating visual acuity for seven days. On examination, vision was limited to light perception on the right eye and was blind on the left; fundoscopy revealed no papilledema. Fluorescein angiography and electroretinogram were normal. MRI of the orbits and brain demonstrated nodular enhancement of the left optic nerve, bilateral trigeminal nerves and both internal auditory canals, albeit without leptomeningeal enhancement. Chest CT scan demonstrated a left lower lobe mass. On CSF cytology atypical epithelial (CK7+) cells were found. Endobronchial biopsy confirmed the presence of non-small-cell lung cancer (NSCLC). Within five days the patient developed impaired right facial sensation, hoarseness (result of right vocal cord paralysis) and left upper extremity paresis. Cervical spine MRI demonstrated two intramedullary enhancing lesions at C2 and C3 level consistent with metastases. Serum and CSF analyses for other infectious or autoimmune etiologies were negative. Given the dismal prognosis, the patient declined further treatment and palliative care was provided Conclusion: Rapidly progressive bilateral optic neuropathy is a very uncommon initial manifestation of MC secondary to NSCLC. The prognosis for vision improvement or survival is dismal. MC should be considered in the differential diagnosis of rapid bilateral visual loss.