[A case of leptomeningeal melanomatosis with acute paraplegia and multiple cranial nerve palsies].

The article discusses a rare case of a 62-year-old man diagnosed with leptomeningeal melanomatosis, presenting with acute paraplegia and multiple cranial nerve palsies, who was unable to undergo therapy and died after two months.

Case Details

• The case study focuses on a 62-year-old man who was transferred to the hospital due to acute paraplegia (a severe form of paralysis).
• The patient displayed symptoms of multiple cranial nerve palsies such as mydriasis of the left pupil, abduction palsy of the left eye, hoarseness and dysphagia. However, there were no meningeal irritation signs.

Diagnostic Process

• Upon examination, MRI results showed swellings of the conus medullaris and the cauda equine along with contrast enhancement of the spinal meninges.
• The Cerebrospinal fluid (CSF) revealed pleocytosis and protein increment, indicating an abnormal condition.
• A swollen lymph node was detected in his right axilla from where a biopsy specimen was taken.
• Upon studying the biopsy, it was revealed that it was a metastasis of malignant melanoma.
• A careful body examination ended up finding a malignant melanoma in the subungual region of the patient’s right ring finger.
• A repeated cytological examination found melanoma cells in the CSF, confirming the diagnosis of leptomeningeal melanomatosis, a rare condition in which melanoma (a type of skin cancer) metastasizes to the meninges (sheaths covering the brain and spinal cord).

Case Outcome

• The study reports that the patient’s consciousness gradually deteriorated after diagnosis.
• The family chose supportive care for the patient after being informed about his condition, opting not to proceed with chemotherapy or surgical therapy.
• The man, unfortunately, died after 60 days in the hospital.

Conclusion

• The conclusion emphasizes on regular follow-up and repeated studies for early diagnosis in such cases, even if the clinical presentation appears atypical.
• This study provides critical insights into the rare case of leptomenigeal melanomatosis presenting with acute paraplegia and multiple cranial nerve palsies, emphasizing the need for careful diagnostic procedures in unusual clinical presentations.