The Importance of Cerebrospinal Fluid Cytology in Leptomeningeal Carcinomatosis Presenting with Intracranial Hypertension

Scientific Background: Leptomeningeal carcinomatosis (LMC) is one of the complications of systemic cancers with the most poor prognosis. Tumor cells in LMC disturb CSF circulation either by spreading into subaracnoid space or directly infiltrating meninx and occasionaly causes intracranial hypertension (IH). Hydrocephalus can be established by neuroimaging methods in the most of patients with IH due to LMC. Meningeal contrast enhancements are also present in some patients. CSF cytology must be examined in patients with IH because of not to missing diagnosis of LMC. Material and method: Three patients presented with IH without findings of hydrocephalus in neuroimaging were diagnosed as LMC by CSF cytologic examination. IH and LMC were initial manifestations of breast carcinoma in the first patient. Our second patient was admitted with epileptic seizures and IH two years after the primary diagnosis of breast cancer. However, the fourth cytologic examination of CSF showed LMC by showing malignant cells. The last patient presented with IH was di-agnosed as gastric carcinoma one and a half month ago and LMC was diagnosed by both CSF cytology and cranial magnetic resonance imaging studies. Conclusions: LMC should be suspected in IH patients even in the absence of hydrocephaly and/or meningeal contrast enhancement in neuroimaging and CSF cytology must examined even if there is no history of cancer.