Meningeal Carcinomatosis with Bilateral Optic Disc Edema in the Absence of Intracranial Hypertensive Symptoms: A Case Report.

Abstract

Introduction: We report a case of meningeal carcinomatosis (MC) presenting with bilateral optic disc edema and an absence of symptoms of intracranial hypertension, such as headache or vomiting.

Case presentation: A 54-year-old woman presented with a 2-week history of bilateral blurred vision and new-onset floaters in the left eye. She had a history of surgeries for both ovarian and gastric cancer while undergoing chemotherapy for recurrent ovarian cancer. Fundoscopic examination revealed bilateral optic disc edema. Although intracranial hypertension was suspected, non-contrast computed tomography and non-contrast magnetic resonance imaging showed no intracranial lesions or enlarged ventricles. Cerebrospinal fluid examination revealed normal opening pressure and cytology demonstrated adenocarcinoma cells, confirming MC. The cell morphology suggested that the metastasis likely originated from her previous gastric cancer. Two weeks after the initial ophthalmologic examination, the patient developed headache and vomiting, and her general condition deteriorated rapidly. Radiation therapy was considered, but the patient died 1 month after the initial presentation.

Conclusion: A diagnosis of MC should be considered in patients with a history of malignancy who present with bilateral optic disc edema, even in the absence of typical symptoms of intracranial hypertension.