[2][3] The term leptomeningeal (from the Greek lepto, meaning 'fine' or 'slight') describes the thin meninges, the arachnoid and the pia mater, between which the cerebrospinal fluid is located.
Leptomeningeal disease is becoming more evident because cancer patients are living longer and many chemotherapies cannot reach sufficient concentrations in the spinal fluid to kill the tumor cells.
The other symptoms may include headaches (usually associated with nausea, vomiting, light-headedness), gait difficulties from weakness or ataxia, memory problems, incontinence, and sensory abnormalities.
[11][1] In some cases, symptoms may include double vision, numb chin,[6] back pain, leg weakness, sphincter-related problems, hydrocephalus,[12] loss of urine control, and difficulty walking.
Spinal signs and symptoms include weakness, dermatomal or segmental sensory loss, and pain in the neck, back, or following radicular patterns.
[citation needed] 3 affected domains of neurological function: Signs reported: Leptomeningeal carcinomatosis occurs when the cancer cells invade the cerebrospinal fluid[5] and spread throughout the central nervous system.
[6] The metastatic tumor cells grow either attached to the pia mater covering the brain and spinal cord or floating unattached to the subarachnoid space.
[citation needed] The first and third patterns are common in solid tumors whereas the second occurs most frequently with leukemia and lymphoma.
[16] Only eight cases of MC arising from squamous cell carcinoma of the uterine cervix are previously reported in the literature.
[citation needed] Infiltration happens most often at the base of the brain, dorsal surface, and especially at the cauda equina, which is largely due to the effect of gravity.
These cells have the ability to penetrate the pial membrane and invade the spinal cord and cranial nerves.
[18] Infiltration from the subarachnoid space into the spinal cord occurs primarily along the perivascular tissues that surround blood vessels at the brain entrance.
[citation needed] With mild infiltration, tumor cells are found diffusely in the subarachnoid space from the cervical to sacral levels.
[19] Screening involves an MRI scan to identify and diagnose tumors in the subarachnoid region of the brain.
[20] Diagnosis is most commonly made by lumbar puncture to detect malignant cells in the CSF, although the tests may be negative in roughly 10% of patients.
If the cytology remains negative and radiological studies are not definitive, consideration may be given to ventricular or lateral cervical spine CSF analysis based on the suspected site of predominant disease.
Chemotherapy is injected directly into the cerebrospinal fluid, either by lumbar puncture (“spinal tap”) or through a surgically implanted device called an Ommaya reservoir.
[citation needed] In the United States, 1–8% of cancer patients are diagnosed with leptomeningeal disease, with approximately 110,000 cases per year.
[30] The exact incidence of leptomeningeal disease is difficult to determine, since gross examination at autopsy may overlook signs of leptomeningeal disease, and microscopic pathological inspection may be normal if the seeding is multifocal or if an unaffected area of the central nervous system (CNS) is examined.
[6] People with leptomeningeal metastasis are generally excluded from clinical trials, thereby limiting the systematic assessment of novel therapies in this subgroup of patients with poor prognosis.