A Case of Meningeal Carcinomatosis from Ovarian Cancer Initially Presenting as Dizziness

Abstract

We encountered a 60-year-old woman with initial symptoms of dizziness diagnosed as meningeal relapse of an ovarian primary, from which meningeal carcinomatosis is very rare. Plain magnetic resonance imaging (MRI) of the brain at a local hospital showed no abnormalities. Although she was treated with oral medicine, her condition remained unimproved and she subsequently complained of right-sided hearing loss. She then visited our hospital. A physical examination on the first visit showed no abnormal nystagmus or cerebellar ataxia, but gadolinium-enhanced MRI of the brain revealed meningeal carcinomatosis. She subsequently showed rapid development of bilateral deafness and died 38 days after admission, despite radiotherapy. Diagnosis of meningeal carcinomatosis requires contrast-enhanced MRI rather than plain MRI. In the literature, dizziness complicated by meningeal carcinomatosis has mainly appeared as drift while walking and has generally proven intractable. No specific findings of nystagmus have been noted, appearing in some cases, but not in others. Conversely, hearing loss resulting from meningeal carcinomatosis usually develops rapidly and results in bilateral deafness. In conclusion, meningeal carcinomatosis is very rare in the natural history of ovarian cancer. In cases showing intractable dizziness and progressive hearing loss, particularly bilateral progressive deafness, meningeal carcinomatosis should be suspected. Contrast-enhanced MRI should be performed aggressively in suspicious cases.