2024 Volume 117 Issue 11 Pages 1019-1024
Leptomeningeal carcinomatosis is a condition that develops when a malignant tumor metastasizes to the subarachnoid space of the cerebrospinal cord, and carries a poor prognosis. In this report, we describe a case of leptomeningeal carcinomatosis in a patient with lung cancer that progressed rapidly with varied cranial nerve symptoms after the patient developed acute sensorineural hearing loss.
A 65-year-old man diagnosed previously as having lung adenocarcinoma presented with the chief complaints of hearing loss and lightheadedness and was referred to us from our radiology department. We diagnosed the patient as having acute left sensorineural hearing loss and began treating him three days after his initial visit. He complained of worsening diplopia and dysphagia on the day after he was hospitalized. Contrast-enhanced cervicothoracic CT and head MRI revealed no abnormal findings. Five days after the initial visit, the ophthalmologist diagnosed left oculomotor nerve palsy as the cause of his diplopia. Six days after the initial examination, we performed a lumbar puncture and cerebrospinal fluid cytology. On the same day, we performed contrast-enhanced MRI of the head, which revealed contrast effects along the brainstem and cerebellum and bilateral internal auditory canals, and nodular lesions in both the cerebellar hemispheres. Taken together with the results of cerebrospinal fluid cytology, we suspected leptomeningeal carcinomatosis. Seven days after the initial examination, cerebrospinal fluid cytology showed class V: adenocarcinoma. The patient was then definitively diagnosed as having leptomeningeal metastasis from lung cancer and transferred to the respiratory surgery department on the same day.
In a patient with a history of malignancy presenting with varied cranial nerve symptoms, it is necessary to promptly perform contrast-enhanced MRI of the head to rule out the possibility of leptomeningeal carcinomatosis.
