Investigations
A repeat MRI Head was performed (Figure 3) which demonstrated mild hydrocephalus with no clear cause. A lumbar puncture (LP) was conducted and analysis of the cerebral spinal fluid (CSF) showed an increased opening pressure, elevated white cell count (lymphocytic), high protein, extremely low glucose and a high lactate (Table 1). Viral PCR, microscopy, bacterial and fungal cultures all revealed no organisms. A CT scan of the Chest, Abdomen and Pelvis failed to identify a primary tumour, however it revealed widespread metastatic bony deposits suggesting the diagnosis of neoplastic meningitis (Figure 4).