PATIENTS WITH MALIGNANT MENINGITIS PRESENTING WITH NEUROPSYCHIATRIC MANIFESTATIONS

Background. Malignant meningitis is often thought of as a late event i n the course of cancer. At one time, it was thought to be rare, but it has been recognized more frequently in recent times. Clinical suspici on of malignant meningitis is prompted by neurologic symptoms and sign s in patients at risk for this oncologic complication. Neuropsychiatri c symptoms previously were not considered as presenting symptoms of ma lignant meningitis, Methods. Three patients with cancer with no neurol ogic symptoms were examined for malignant meningitis based on neuropsy chiatric symptoms, Cerebrospinal fluid was examined for malignant cell s to confirm the diagnosis of malignant meningitis. Results. The clini cal presentation of malignant meningitis for three patients was neurop sychiatric. None of the patients had delirium during their initial pre sentation. Conclusions. It is important that clinicians recognize that psychiatric symptoms without neurologic findings may indicate maligna nt meningitis and that malignant meningitis needs to be included in th e differential diagnosis of neuropsychiatric disorders in patients wit h cancer.