Hypoglycorrhachia in meningeal carcinomatosis

A case of malignant melanoma with diffuse meningeal carcinomatosis and hypoglycorrhachia is presented. The combination of low spinal fluid glucose and bizarre or unexplained neurologic signs should bring to mind meningeal carcinomatosis. In the presence of known malignant disease and fever hypoglycorrhachia should stimulate a diligent search of the spinal fluid for recognizable malignant cells. The proposed mechanism for development of hypoglycorrhachia in malignant disease is either accelerated anaerobic glycolysis by malignant cells or mechanical blockade of the blood cerebrospinal fluid barrier or a combination of both factors. The advent of techniques for meningeal perfusion with cancer chemotherapeutic agents further emphasizes the importance of pursuing the diagnosis of neoplastic meningeal implants.