RT Journal Article
SR Electronic
T1 Headache in a young woman: leptomeningeal metastasis as the first presentation of underlying breast malignancy
JF BMJ Case Reports
FD BMJ Publishing Group Ltd
SP bcr2014207643
DO 10.1136/bcr-2014-207643
VO 2015
A1 Poornima Mohan
A1 Marilina Antonelou
A1 Ophelia Dadzie
A1 Simon Dubrey
YR 2015
UL http://casereports.bmj.com/content/2015/bcr-2014-207643.abstract
AB A 37-year-old woman presented with a 2-week history of persistent headache in an occipitotemporal distribution. The patient had experienced prior headaches and migraines, but this presentation was characterised by its intensity and duration. There was associated dizziness and blurring of vision in episodes occurring up to 4–5 times per day. Whole body cross-sectional CT imaging and MRI of neuronal axes were normal. Cerebrospinal fluid cytology demonstrated large abnormal pleomorphic cells expressing the tumour marker CA125. Positron emission tomography-fluorodeoxyglucose revealed bilateral axillary and cervical lymphadenopathy as well as increased uptake in the lateral regions of both breasts. These results correlated with MRI breast and mammography findings. Axillary lymph node biopsy showed poorly differentiated adenocarcinoma making the diagnosis of breast malignancy, the most likely primary site of metastatic leptomeningeal disease. In the 6-week interval between initial presentation and diagnosis, the patient deteriorated significantly with the new onset of facial nerve palsy and partial seizures. The treatment intent was palliative, focusing on symptom control with systemic chemotherapy and whole brain radiotherapy.