Abstract
We describe a patient with leptomeningeal carcinomatosis in whom no primary malignancy was found in spite of extensive laboratory investigations. The diagnosis was supported, however, by cytological and biochemical CSF examination. Of particular interest in this setting was the low level of glycorrhachia. In order to understand better the mechanism of hypoglycorrhachia, the patient was subjected to I.V. glucose loading; serial samples of blood and CSF were obtained to determine glucose and lactic acide levels. We found that: 1) The low CSF glucose concentration was not increased by I.V. infusion of sugar; 2) the high basal CSF lactic acid level was not further stimulated by I.V. glucose loading. These data suggest that hypoglycorrhachia was not due to an increased utilization of glucose by neoplastic cells that infiltrate the meninges but to abnormal transport of glucose from blood to CSF.
Sommario
Viene descritta una paziente affetta da carcinomatosi meningea nella quale, nonostante le approfondite indagini strumentali, non si è obiettivata alcuna neoplasia primitiva. La diagnosi è stata confermata dall’esame citologico e biochimico del liquor. Di particolare interesse è la bassa concentrazione di glucosio nel liquido cefalo rachidiano. Al fine di chiarire il meccanismo della ipoglicorrachia, la paziente è’stata sottoposta ad un carico endovenoso di glucosio, con successiva determinazione in campioni seriati di sangue e liquor dei livelli di glucosio ed acido lattico. Sulla base dei risultati ottenuti gli autori giungono alla conclusione che: 1) la bassa concentrazione di glucosio nel liquor non è influenzata dall’infusione endovenosa di glucosio; 2) gli alti valori basali di acido lattico liquorale non vengono ulteriormente incrementati dal carico endovenoso di glucosio. Questi dati suggeriscono che la ipoglicorrachia non è dovuta ad un aumentato utilizzo di glucosio da parte delle cellule neoplastiche infiltranti le meningi, ma ad un abnorme trasporto di glucosio dal sangue al liquido cerebro spinale.
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Jann, S., Comini, A. & Pellegrini, G. Hypoglycorrhachia in leptomeningeal carcinomatosis A pathophysiological study. Ital J Neuro Sci 9, 83–88 (1988). https://doi.org/10.1007/BF02334413
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DOI: https://doi.org/10.1007/BF02334413