A Case of Meningeal Carcinomatosis of Gastric Cancer-causing Rapid Loss of Visual Acuity and Visual Field Defects in Both Eyes

<p>　We presented a patient with gastric cancer that was preceded by rapidly progressing visual acuity and field disturbances, who had no intracranial hypertensive symptoms such as headache or papilledema, and who had an enhancement effect on the optic nerve sheath on magnetic resonance imaging (MRI) . The patient was diagnosed with meningeal carcinomatosis to the optic nerve by direct infiltration of cancer cells.</p><p>　The patient was a woman in her 50s who underwent laparoscopic pyloric gastrectomy for gastric cancer 2 years previously. She received postoperative adjuvant chemotherapy; however, peritoneal dissemination was observed afterward. She became aware of blurred vision during chemotherapy. At the time of her initial visit, she had corrected visual acuity of 20/50 in the right eye and 10/50 in the left eye, and the kinetic perimetry test showed a cecocentral scotoma in both eyes. No remarkable findings were observed during slit lamp or ophthalmoscopic examination. However, MRI showed contrast effects on the bilateral optic nerve sheath and other multiple cranial nerves, leading us to suspect meningeal carcinomatosis. On cerebrospinal fluid cytology, Class V positive adenocarcinoma cells were detected, and the patient was diagnosed with meningeal carcinomatosis.</p><p>　When a patient with a tumor-bearing cancer presents rapid loss of vision and visual field impairment, meningeal dissemination of the cancer cells to the optic nerve should be considerd.</p>