A case of carcinomatous meningitis with occult primary malignancy

Carcinomatous meningitis (CM) or Leptomeningeal metastasis is defined as infiltration of leptomeninges by malignant cells. It complicates the course of 5% of solid tumours. CM as a presentation of an unknown primary malignancy is rare with an incidence of 1–7%. We report a case of 49-year-old female who presented with acute onset and rapidly worsening headache, vomiting and blurring of vision. Initially she was treated as case of acute meningitis. However, her cerebrospinal fluid (CSF) study showed presence of atypical cells suggesting neoplastic etiology. Flourodeoxy glucose (FDG) PET scan showed two FDG avid portocaval lymph nodes. Needle aspiration cytology of these lymph nodes showed features suggestive of metastatic adenocarcinoma.