Unusual Manifestations of Meningeal Carcinomatosis

To the Editor.—  Meningeal carcinomatosis (MC) occurs in 5% of patients with stage IV breast cancer and usually is manifested by increased intracranial pressure and cranial nerve or spinal root dysfunction.¹ We have seen two patients with breast cancer who demonstrated unusual initial manifestations. In the first patient frontal sinus pain developed one week before extremity weakness and slurred speech were noted. Sinus, skull, and orbital roentgenograms were normal. Computerized tomography of the brain was normal. Spinal fluid examination demonstrated malignant cells. In the second patient unexplained, severe orthostatic hypotension developed after whole-brain irradiation for parenchymal brain metastases. Results of neurologic examination were normal, but spinal fluid showed malignant cells. Orthostatic hypotension promptly responded to intrathecally given methotrexate.These manifestations of MC were seen only once each in a series of 50 patients followed up at M. D. Anderson Hospital, Houston. Frontal sinus pain reflects involvement of the supraorbital