Crucial differential diagnosis of rapidly progressive dementia: A case of leptomeningeal metastasis

Dementia that advances subacutely without accompanying neurological symptoms can often be misdiagnosed as a psychiatric condition. Leptomeningeal metastasis (LM), caused by the spread of malignant cells to the leptomeninges and the subarachnoid space, is a relatively unfamiliar condition to psychiatrists in this context. The diagnosis of LM remains challenging due to the scarcity of diagnostic tools possessing high sensitivity and specificity.We present the clinical presentation of a male in his seventies with LM secondary to gastric ring cell carcinoma. The patient exhibited an acute confusional state, visual hallucinations, irritability, and cognitive impairments over a 3‐week period. Initially, the patient was misdiagnosed with several conditions, including alcohol withdrawal syndrome, psychosis, and delirium associated with dementia, as there were no noteworthy findings on neurological examination or the head magnetic resonance imaging (MRI). Given the rapidly progressive cognitive decline, we maintained vigilance for potential neurological conditions, and a repeat investigation using head MRI and cerebrospinal fluid analysis led to the diagnosis of LM.This critical case report underscores the rarity of psychiatric‐onset LM originating from gastric cancer and highlights the importance of comprehensive neurological evaluations.

[1]  Xiaoqin Huang,et al.  Sensorineural Hearing Loss as the Prominent Symptom in Meningeal Carcinomatosis , 2021, Current oncology.

[2]  Enyan Yu,et al.  A narrative review of risk factors and interventions for cancer-related cognitive impairment , 2020, Annals of translational medicine.

[3]  G. Winocur,et al.  Cancer-Related Cognitive Impairment: An update on state of the art, detection, and management strategies in cancer survivors. , 2019, Annals of oncology : official journal of the European Society for Medical Oncology.

[4]  Leung William Chun-Yin,et al.  Pitfalls in cerebrospinal fluid analysis: A case report of carcinomatous meningitis mimicking infective causes. , 2019, Journal of the Formosan Medical Association = Taiwan yi zhi.

[5]  D. Ffytche,et al.  Visual Hallucinations in the Psychosis Spectrum and Comparative Information From Neurodegenerative Disorders and Eye Disease , 2014, Schizophrenia bulletin.

[6]  Alfonso L. Sabater,et al.  Ocular symptoms secondary to meningeal carcinomatosis in a patient with lung adenocarcinoma: a case report , 2012, BMC Ophthalmology.

[7]  I. Hwang,et al.  Gastric leptomeningeal carcinomatosis: multi-center retrospective analysis of 54 cases. , 2009, World journal of gastroenterology.

[8]  J. Sejvar,et al.  Rapidly progressive dementia , 2008, Annals of neurology.

[9]  R. Wolff,et al.  Neoplastic meningitis in patients with adenocarcinoma of the gastrointestinal tract , 2005, Cancer.

[10]  C. Straathof,et al.  The diagnostic accuracy of magnetic resonance imaging and cerebrospinal fluid cytology in leptomeningeal metastasis , 1999, Journal of Neurology.

[11]  P. Brastianos,et al.  Leptomeningeal metastasis from systemic cancer: Review and update on management , 2018, Cancer.

[12]  A. Valentine,et al.  Charles Bonnet syndrome as a manifestation of leptomeningeal metastases. , 2010, Psychosomatics.

[13]  J. Gomori,et al.  Leptomeningeal metastases: evaluation by gadolinium enhanced spinal magnetic resonance imaging , 2004, Journal of Neuro-Oncology.

[14]  M. Seidel,et al.  The phenomenology of perceptual hallucinations in alcohol-induced delirium tremens. , 1995, Psychopathology.