Meningiosis carcinomatosa presenting with vertigo and hearing loss

Vestibulocochlear disorders are every-day clinical pictures for ENT physicians. In the following case, however, the cause of the initially typical vestibulocochlear disorder is rather unusual.

When presenting to the ER the 58-year old woman complained of severe vertigo and left-sided profound hearing loss. Two months earlier she had been treated with oral steroids for left-sided hearing loss and tinnitus, but without relevant success. In addition, a CAT scan 3 weeks later had revealed no intracranial pathologies. Medical history included a mamma carcinoma, which had been treated with surgery and radiochemotherapy four years earlier. Clinical examination revealed a spontaneous nystagmus to the right, a tendency of falling to the left and lateralisation of weber’s test to the right. The patient was admitted and treatment with intravenously administered steroids was started. Diagnostics showed a profound sensorineural left-sided hearing loss, but also revealed bilateral otoacustic emissions. A subsequent brainstem evoked response audiometry showed no responses for the left side at 95 dB. Videonystagmography resulted in an alternating spontaneous nystagmus without difference between left and right caloric response. Thus, clinical history and findings suggested a central cause of the vestibulocochlear symptoms. A subsequent MRI revealed a meningiosis carcinomatosa with cerebellar metastasis and expansion into the left inner auditory canal with edema. The patient was then transferred for palliative whole brain radiation. The severe, restrictive vertigo symptoms persisted even afterwards. Although vestibulocochlear disorders are often of idiopathic peripheral nature, central causes have to be ruled out, especially when the patient has a past medical history of a malignant tumor.

Poster-PDF A-1333.pdf

Publikationsverlauf

Artikel online veröffentlicht:
13. Mai 2021