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Título

MENINGEAL CARCINOMATOSIS MIMICKING A PSYCHIATRIC CONDITION: CASE REPORT

RESUMO

Case presentation: A 45-year-old previously healthy man, who works in an accounting office, comes to the doctor with a complaint of sudden disorientation, delusions, and vomiting for 20 days. The confused mental state caused dependence on others for all activities for one week, then, he partially improved his state for five days and worsened again. He reported a daily headache of strong intensity. He denies seizures, allergies, or comorbidities. His family brought him to the consultation, directing him to a psychiatric condition due to behavioral change, and for having a family history (mother) of severe depression. He denies alcoholism or smoking. On physical examination, the patient does not cooperate, obeys simple commands with difficulty, does not obey complex commands, appears unaware of his surroundings, strength preserved, vivid and symmetrical reflexes, cutaneous-plantar reflex in bilateral flexion, isochoric and photoreactive pupils, preserved extrinsic ocular motricity, mimicry symmetrical face. During the investigation, magnetic resonance imaging (MRI) revealed hypersignal in the sulci of the cerebral hemispheres, associated with gadolinium enhancement in a leptomeningeal pattern. Cerebrospinal fluid (CSF) revealed the presence of neoplastic cells. After screening for neoplasms, non-small cell lung carcinoma was identified. Discussion: Meningeal carcinomatosis (MC) is a rare neurological complication characterized by multifocal invasion of the meninges by neoplastic cells. Breast, lung, and melanoma tumors are the main ones responsible for the cases. About 5% of all cancer patients have meningeal carcinomatosis, lung adenocarcinoma is the one that most often affects the meninges when referring to non-small cell cancer. In the present case, the patient presented behavioral changes associated with bradypsychia and headache. MC is a late event in the evolution of the neoplasm and can manifest with the involvement of spinal roots, cranial nerves, and/or lesions of the cerebral hemispheres. The diagnosis is based on clinical findings, neuroimaging, and CSF analysis. It has an unfavorable prognosis, survival is 3 to 6 months in patients undergoing treatment. Final comments: This clinical case is unusual due to the low frequency of MC and the presence of neuropsychiatric manifestations in the absence of a previous diagnosis of neoplasia. In addition, behavioral changes may be a rare and early sign of meningeal carcinomatosis.

Palavras Chave

meningeal carcinomatosis, lung carcinoma, psychiatric condition.