BioMed Research International / 2015 / Article / Tab 1

Research Article

Meningeal Melanomatosis: A Challenge for Timely Diagnosis

Table 1

Clinical and paraclinical findings in our three patients.

Pt123

Age/gender17/M55/M65/M

Clinical presentation at onset Headache, nausea and vomiting, diplopia, and weight loss Left leg monoparesis, headache, nausea and vomiting Recurrent confusional episodes

MRI
 Time from symptom onset (weeks)430478.212.9121.4
 HydrocephalusNoModest dilation of ventricular systemTetra-ventricularTriventricularTriventricularNoTriventricular
 Leptomeningeal contrast enhancementNoContrast not administeredSupra- and infratentorial, cranial nerves, spinal cord, conus, and cauda equinaSupratentorial, conus, and cauda equinaSupratentorial, spinal cord, conus, and cauda equinaNoSupra- and infratentorial, cranial nerves, conus, and cauda equina
 Dural melanin depositsNoNoYesNoNoNoYes

CSF
 Time from symptom onset (weeks)40.642.944.98.110.614.921.4
 Glucose (mg/dL)9283298
 Proteins (mg/dL)23662773370431535
 Cell count (cells/uL)41101742<21036
 Cytologyn.p.NonspecificMelanoma cellsn.p.No identifiable cellsNonspecificMelanoma cells

EEG Poorly organized background activity with bilateral slow abnormalities Diffuse bilateral slowing Bilateral fronto-centrotemporal slow abnormalities with left prevalence

Extra CNS visceral metNoNoNo

Final diagnosisPrimary leptomeningeal melanomatosisPrimary leptomeningeal melanomatosisLeptomeningeal carcinomatosis and cutaneous melanoma

Time to diagnosis (weeks)471723.4

Clinical evolution Confusion, visual hallucinations, partial seizures, and behavioral alterations Urinary retention, progressive paraparesis, and visual hallucinations Vigilance impairment, generalized seizures, headache, and backache

TreatmentTemozolomide (I cycle)Dacarbazine (I cycle)None

Overall survival (weeks)49.123.430

Legend to Table 1: CNS = central nervous system, CSF = cerebrospinal fluid, EEG = electroencephalogram, met = metastases, MRI = magnetic resonance imaging, n.p. = not performed, and — = not available.

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