MENINGEAL CARCINOMATOSIS - A RARE COMPLIC ATION OF BLADDER-CANCER

The sites of metastases of transitional cell carcinoma of the bladder are nodes, liver, lung and bone, but the meningeal infiltration is rar e. Therefore, one case of meningeal carcinomatosis is reported. After cystectomy for an undifferentiated carcinoma of the bladder, the patie nt received adjuvant chemotherapy. Three months after treatment comple tion, symptoms of cerebellar ataxia occurred and gradually confusion a ppeared. The initial cerebro spinal fluid showed clumps of malignant c ells. The patient died 15 days after tile neurological symptoms occurr ed. The clinical diagnosis of meningeal carcinomatosis is based on neu rological manifestations at more than one level of the neuraxis. Sympt oms may present simply as headache or confusion. Meningeal carcinomato sis from urothelial cancer seems to show some specific features: poorl y differentiated tumour and high frequency of cerebellar symptoms. Int rathecal treatment essentially has a pain-effect. Mean survival time i s as short as 20 weeks. The increasing incidence of this neurological complication. in urothelial cancer does not only result from an increa se in patient longevity but also from possible side-effects of chemoth erapy, so as localized changes in blood-brain barrier permeability ind uced by antineoplastic drugs. Therefore, we may wonder whether meninge al carcinomatosis might not be regarded as an iatrogenic effect.