Cumhur ARTUK, Zehra KARACAER, Gonca FİDAN, Gülden YILMAZ

Menenjit ĝle KarÖĹan Leptomeningeal Metastaz Olgu Sunumu

Bu olgu sunumunda bir aydır devam edip son iki haftadır şiddeti artan baş ağrısı, bulantı, kusma,ışığa intolerans şikayetleri olan 52 yaşında bir kadın hasta sunulmaktadır. Bir yıl önce meme kan--seri tanısı alan hastanın kemoterapi ve radyoterapi tedavisi ay önce tamamlanmıştır. Klinik,lomber ponksiyon ve ilk magnetik rezonans görüntüleme (MRG) bulguları ile meneningoense--falit düşünülerek empirik antibiyoterapi başlanmıştır. Antibiyotik tedavisine yanıt alınamadığıiçin beyin omurilik sıvısında (BOS) sitolojik inceleme yapılmış ve tekrarlanan MRG'de serebel--lumda lineer tarzda leptomeningeal tutulum görülmüştür. Klinik bulgular ve radyolojik görün--tüleme sonucu ile meme kanserine bağlı leptomeningeal metastaz (LM) tanısı konulmuştur. Üçhafta yoğun bakım ünitesinde (YBÜ) takip edilen hasta kaybedilmiştir. Çok farklı klinik tablolaroluşturabildiğinden dolayı tanıda gecikmeler yaşanmaktadır. Bu vaka LM'in, meningoensefalitile karışabileceğini göstermesi bakımından dikkat çekicidir.

Case Report: Leptomeningeal Metastases Mistaken Meningitis

In this case report 52 years old woman having severe headache for two weeks, nausea, vomitingand intolerence to light has been reported. year ago she was diagnosed as breast cancer; che—motherapy and radiotherapy treatment has finished months ago. With findings of lomber punctureand magnetic resonance imaging (MRI), meningoencephalopathies has considered and am—piric antibiotic treatment has begun. In spite of appropriate antibiotics our case consciousnessstate has not changed so cytologic analyses of cerebrospinal fluid (CSF) and second MRI has beenperformed and reportes as lineer leptomeningeal infiltration at cerebellum. With clinical symp—toms and MRI findings our case was diagnosed as leptomeningeal metastases (LM). Three weekslater the patient died at intensive care unit (ICU). Diagnosis of LM is difficult because it can be pre—sented in different clinical situations. So some patients can diagnosed lately. This case is importantin the cause of showing LM can be misdiagnosed as meningoencephalopathies.

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