Blindness as initial manifestation of meningeal carcinomatosis in breast cancer.

The sudden onset of blindness in adults, with or without a history of malignancy should raise the possibility of meningeal carcinomatosis. The diagnosis is best confirmed with examination of the spinal fluid. The actual mechanism by which blindness occurs is probably a combination of tumor cuffing around the optic nerve, direct infiltration and chronic papilledema. We are reporting two patients with disseminated breast cancer who presented with blindness as the first manifestation of meningeal involvement. Treatment with whole brain radiation and intrathecal Cytosine Arabinoside produced temporary remissions, but both died a few months later of their cancer.