A case of facial nerve paralysis caused by meningeal metastasis of bladder cancer

Abstract

Typical causes of facial nerve paralysis are Bell's palsy and Ramsay Hunt syndrome. Facial nerve paralysis caused by a neoplastic lesion is a relatively rare occurrence. We herein report a very rare case of facial nerve paralysis that was caused by the meningeal metastasis of bladder cancer. The patient was a 59-year-old male who had a history of cystectomy for superficial bladder cancer 6 months prior to the onset of facial palsy. He underwent systemic steroid treatment at another hospital, but his facial nerve function did not recover. At our hospital, he had paralysis in the right glossopharyngeal nerve and right vagal nerve, in addition to the facial nerve. A gadolinium-enhanced MRI examination revealed a thickened dura matter and soft tissue in the mastoid antrum. A cytological examination of his otorrhea revealed that his middle ear carried a malignant neoplasm of uncertain pathology. A pathological diagnosis was made tissue findings obtained by an open biopsy following mastoidectomy. In the case of facial nerve paralysis due to a poor response to steroid treatment, palsy due to a primary or metastatic tumor should therefore be considered in the differential diagnosis.