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Case Reports
. 2022 Jul 8;14(7):e26658.
doi: 10.7759/cureus.26658. eCollection 2022 Jul.

Ophthalmoplegia in a Her2+ and β-hCG+ Patient With Leptomeningeal Carcinomatosis Secondary to Gastric Adenocarcinoma

Zachary Falk  1 , Mei Bou Nasif  2 , Nabil Fallouh  1
Affiliations
Case Reports

Ophthalmoplegia in a Her2+ and β-hCG+ Patient With Leptomeningeal Carcinomatosis Secondary to Gastric Adenocarcinoma

Zachary Falk et al. Cureus. .

Abstract

Leptomeningeal carcinomatosis (LMC) is an uncommon and devastating late complication of metastatic malignancy that carries a poor prognosis, typically faring worse when secondary to solid tumors. Diagnosis of LMC can be challenging, especially if the underlying cancer is undiagnosed, as presenting symptoms can be nonspecific or involve focal deficits such as cranial nerve palsies. Typically, LMC can be recognized due to new central neurological findings with concomitant peripheral nerve involvement, but there has not been a case of LMC with isolated peripheral nerve findings to our knowledge. In this report, we present a case of LMC secondary to metastatic gastric adenocarcinoma in a patient whose only manifestation was cranial nerve palsies, and whose cancer was also found to be Her2+ and β-hCG positive, two markers not widely recognized in gastric cancer.

Keywords: gastric adenocarcinoma; her2-positive; leptomeningeal carcinomatosis (lmc); ophthalmoplegia; β-hcg.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Gastric mass as seen from upper endoscopy.
Figure 2
Figure 2. CT chest/abdomen/pelvis with contrast.
CT chest/abdomen/pelvis with contrast demonstrating gastric wall thickening (arrows), perigastric stranding, edema, and free fluid.
Figure 3
Figure 3. Brain MRI.
a) Enhancing cerebellar lesion on the right. b) Abnormally-enhancing cerebellar lesion on the left and left cranial nerve (CN) VI enhancement. c) Enhancement of the right Meckel’s cave (upper arrow) and slight enhancement of the right CN VI. d) Bilateral enhancement of the prepontine cisterns.
Figure 4
Figure 4. Spine MRI.
a) Scattered leptomeningeal nodules along the cervical spine. b) Diffuse leptomeningeal enhancement. c) Scattered leptomeningeal nodules along the thoracic spine. d) Scattered leptomeningeal nodules along the lumbar spine.
See this image and copyright information in PMC

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