Meningeal gliomatosis

Gliomatous meningitis is a tumoral meningitis defined as diffuse invasion of the meninges by glioma cells. It occurs in 4-20% of cerebral gliomas. Primary forms are exceptional.

The clinical picture is similar to that of carcinomatous meningitis, dominated by meningeal signs (headache, etc.), involvement of the cranial pairs, spinal pain and bilateral or tilting radicular pain.

The diagnosis should be made in the presence of any unexplained multifocal neurological involvement or hydrocephalus in a known glioma patient (even if the tumour is considered to be in "remission").

Diagnosis is very difficult: glioma cells are only detected in cerebrospinal fluid (CSF) in 20-50% of cases on direct examination → it is essential to inform the pathologist of the suspected diagnosis, so that he or she can carry out immunostaining with an anti-GFAP antibody. MRI, although non-specific, can be suggestive (ventriculitis, linear or nodular meningeal contrast).

Treatment combines chemotherapy and radiotherapy to varying degrees, along the lines of those for high-grade gliomas.

Bibliography

Bradley WG et al., Neurology in clinical practice, 5th ed., Butterworth-Heinemann, e-dition, 2007

Cambier J et al., Neurologie, 13e édition, Masson, 2012

Osborn AG, Diagnostic imaging : brain, Amirsys, USA, 2d ed., 2009

Pradat PF, Méningites chroniques, Encycl Méd Chir (Elsevier), Neurologie, 17-160-C-30, 2002