Multifocal neurologic signs and symptoms are the hallmark of LM. Symptoms can be divided into CNS, cranial neuropathies or spinal/radicular (Table 2). The mechanisms in which LM cause neurological signs and symptoms include obstruction of CSF flow or drainage with resultant increased intracranial pressure (ICP), meningeal irritation, or focal signs from local invasion or irritation of the brain, cranial nerves, spinal cord or spinal nerves. LM can cause cerebral infarction from a cerebral vasculopathy; changes in brain metabolism and reduction in cerebral blood flow may cause a diffuse encephalopathy.62, 106 Isolated neurologic symptoms occur in 30-53 % of patients with LM,9,61,85,131,135,137 with CNS85 and spinal/radicular61 the most common. Multifocal involvement is seen in 40-80 % of cases.9,61,85, 131, 135 137 In one study, a combination of two sites was seen in 47 % of cases (CNS 29 %, CNS and spinal/radicular 10%, and spinal/radicular 8%) and involvement of all levels was seen in 13% of patients.137 Historically, it has been said that signs are much more significant than symptoms;85 for example, a patient may complain of headache, but on examination has facial weakness, dorsiflexor weakness and an absent deep tendon reflex.
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