Lumbar puncture analysis

Leptomeningeal Metastases (LM) can be difficult to diagnose, and I hope you end up clear of it!

Below from my MBC Guide is a brief overview. You (and others) are welcome to request a complimentary copy of the 120+ page booklet by visiting the top of this page:https://community.breastcancer.org/forum/8/topics/831507?page=2#idx_32

Symptoms of LM may include headache, backache, loss of sensation in the face (especially the chin), loss of bladder or bowel control, constipation, dizziness, extreme fatigue, confusion, weakness or loss of sensation in the legs and inner thighs, vision problems and/or hearing difficulties.Elevated CerebroSpinal Fluid (CSF) pressure, white blood count, and protein levels, and lowered glucose levels can also be signs of LM.Some patients with LM have no symptoms at all.

LM occurs when breast cancer spreads to the meninges, which are layers of tissue that cover the brain and the spinal cord.Metastases can spread to the meninges through the blood or they can travel from brain metastases via the cerebrospinal fluid that flows through the meninges.About 2% to 5% of patients with metastatic breast cancer experience LM.

Although LM usually occurs at a later stage in the course of metastatic breast cancer, in very rare instances, it can occur as a first metastasis.LM is difficult to treat because many drugs are not able to penetrate from the bloodstream through the meninges into the cerebrospinal fluid. Often brain metastasis and LM occur at the same time.For that reason, women diagnosed with LM should also have an MRI of the brain.From: http://brainmetsbc.org/en/content/leptomeningeal-metastases-1

LM can be difficult to diagnose. The most common method is by withdrawing spinal fluid with a needle and examining it for breast cancer cells.This procedure is called a spinal tap or lumbar puncture.If the first lumbar puncture comes out negative, it must be repeated two more times to assure a 90% chance of an accurate diagnosis.Doing one puncture only assures a 45% accuracy.It is important that the lumbar puncture be close to the site of the suspected area of leptomeningeal metastasis.An MRI with gadolinium (a contrast agent) of the entire brain and spine can also be used to diagnosis LM and may be better than a CT scan.An MRI with a radioactive tracer can also be used to locate obstructions in the spinal fluid or blood flow caused by LM.However, on an MRI, inflammatory disease or local infection can sometimes be mistaken for LM.From: http://brainmetsbc.org/en/content/leptomeningeal-metastases-1

Once LM is diagnosed, it is important to check:

• The patient's ER, PR and HER2 status, as this will help to determine potential therapies.

• Whether the disease is bulky or diffuse:

• Bulky Disease: Radiation therapy is only given to relieve symptoms in areas of bulky disease because chemotherapeutic agents do not appear to penetrate tumors or nodules (smaller tumors) in the meninges. From: http://brainmetsbc.org/en/content/leptomeningeal-metastases-1
• Diffuse Disease: Chemotherapy is given for diffuse disease and may extend life for several months, or sometimes for a longer time. From: http://brainmetsbc.org/en/content/leptomeningeal-metastases-1

• Whether IntraCranial Pressure (ICP) is elevated. If intracranial pressure is elevated, radiation may be a way to relieve CerebroSpinal Fluid (CSF) obstruction if needed. Relief of CSF outflow obstruction has been shown to improve functional status and is likely to prolong survival in these cases.A VentriculoPeritoneal Shunt (VPS) placement procedure can be used, which carries a small risk of hemorrhage, infection, or shunt malfunction.However, placement of a VPS is a definitive treatment for elevated ICP, and may be combined with a reversible on/off valve to facilitate administration of IntraThecal (IT) chemotherapy.For those in whom a surgical procedure is not desired or tolerable, palliative Radiation Therapy is also effective in relieving CSF outflow obstruction, although the duration of benefit is variable.From: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623833/

AZlexie, you are very welcome!