Dural metastasis causing seizures after treatment for signet-ring gastric cancer

What happened, in summary

A 39-year-old woman had been diagnosed 8 months earlier with signet-ring cell adenocarcinoma in the cardia of the stomach with abdominal lymph-node involvement. She received neoadjuvant docetaxel, oxaliplatin, leucovorin and 5-fluorouracil, followed by total gastrectomy, extensive lymph-node dissection and splenectomy. Follow-up PET and CT imaging had not shown systemic relapse.

She then presented with repeated episodes of confusion and headache. Within days she developed increasingly frequent generalized seizures, persistent drowsiness, worsening headache and vomiting. Anti-seizure medicines, corticosteroids and measures to reduce intracranial pressure produced little improvement.

Further neurologic evaluation showed diffuse cancer involvement of the dura mater covering both cerebral hemispheres, without a typical brain mass or subdural bleeding. This represented a rare distant recurrence of her gastric cancer and therefore Stage IV disease. The oncology team considered palliative intrathecal methotrexate, but her condition deteriorated too rapidly for it to be started. Supportive treatment continued with corticosteroids and anti-seizure medicines.

She died 16 days after arriving at the hospital, roughly 8 months after the original gastric-cancer diagnosis. The case is notable for the speed of the neurologic decline and for dural metastasis presenting mainly with headache, confusion and seizures despite earlier body imaging showing no obvious systemic recurrence.