Leptomeningeal Neoplasms.

Leptomeningeal metastases are a late, devastating complication of systemic cancer that typically occurs in conjunction with other systemic relapse. The most common neurologic symptoms include headache, altered mentation, and difficult walking. Diagnosis is established by neuroimaging and cerebrospinal fluid analysis. The prognosis is poor with a median survival of 6 to 8 weeks; therefore most treatment interventions are palliative. Radiotherapy should be given to sites of bulky or symptomatic tumor. Intrathecal chemotherapy is most effective in patients with lymphoma, leukemia, and breast cancer. Systemic chemotherapy may be more effective in treating bulky leptomeningeal tumor. Ventriculoperitoneal shunting can be extremely useful in patients with obstructive hydrocephalus or increased intracranial pressure.