Multiple radiculopathy of the lower limbs in a cancer patient with meningeal carcinomatosis

Meningeal carcinomatosis occurs in 1%-5% of patients with breast cancer. Ea rly diagnosis and aggressive treatment of neurologic involvement are import ant factors of prognosis. We report a case of a 52-year-old woman who was a ffected by bilateral breast carcinoma treated with surgery and chemotherapy . Six years after she had become asymptomatic, X-rays showed lumbar spine m etastases which were treated with radiotherapy. After 1 year she began to s uffer from lower limb paresthesias, unsteadiness and unstable gait. Clinica l examination showed lower limb sensory ataxia with lack of knee and ankle reflexes, and hypopallesthesia from the iliac spine to the foot. Spinal mag netic resonance imaging (MRI) with contrast agent revealed no medullar comp ression Electromyography disclosed bilateral involvement of L4-L5-S1 roots and corresponding paraspinal muscles. Sensory and motor conductions were no rmal. Cerebrospinal fluid (CSF) examination showed the presence of neoplast ic cells, confirming the diagnosis of meningeal carcinomatosis. Our patient underwent 9 cycles of intrathecal methotrexate therapy (25 mg/cycle) with improvement of ataxia and relief of paresthesias. One year later, CSF exami nation is still negative. We point out the importance of electrodiagnostic studies and CSF examination in the early documentation of root involvement in cancer patients, when computed tomography, MRI and myelography are norma l. Early diagnosis may lead to effective therapy which prolongs survival.