gms | German Medical Science

Breast cancer is the most common solid tumour that causes a meningeosis carcinomatosa. The meningeosis carcinomatosa is the first manifestation of a tumor in just 10 percent of all cases.

We report about a 75-year old woman involved in a road accident as pedestrian. She was injured by a car and suffered a severe traumatic brain injury. After secondary deterioration of her neurological status with increasing cerebral edema and left sided intracranial, extracerebral haemorrhage as well as the traumatic intracerebral haemorrhage a decompressive hemicraniectomia was executed. Parts of brain tissue out of a contusion were sent to histological survey. Sporadic small clusters of tumour-cells were detected. Those showed to be HER-2/neu positive (score 3+). The following MRI of the neurocranium, ultrasound of the mammae, and mammography neither showed breast cancer nor cerebral metastasis. The patient was transferred into rehabilitation with Wernicke's aphasia and a hemiparesis on the right side. The hemiparesis and the patients general condition impaired four weeks post trauma after initial improvement. Computed tomography displayed no signs of an intracranial mass lesion or tumour. Neurological impairments improved after administration of dexamethason. As a result of the oncological conference, a progression of the meningeosis carcinomatosis has to be assumed.

Summarised, in this case we assumed a very vulnerable area of brain tissue with clusters of tumour cells that was more likely to generate the traumatic intracerebral haemorrhage and the brain contusion after severe brain injury.