Journal d'otologie et de rhinologie

Leptomeningeal Carcinomatosis from Urinary Bladder Carcinoma Causing Bilateral Sensorineural Deafness and Vertigo

Crispin Leishman, Patric Hagmann and Raphael Maire

Leptomeningeal Carcinomatosis from Urinary Bladder Carcinoma Causing Bilateral Sensorineural Deafness and Vertigo

Leptomeningeal carcinomatosis is a relatively uncommon complication of certain types of solid tumours, among them urinary bladder carcinoma is especially rare. Sudden sensorineural hearing loss associated with vestibular areflexia is a very rare presentation of this disease. We report a case of a 67-year-old man treated by surgery and adjuvant chemotherapy for a transitional cell urinary bladder carcinoma who complained of sudden hearing loss associated with vertigo four months after his oncological treatment. Initial computed tomography of the brain on arrival showed no metastatic lesions. Examination by the otolaryngologist revealed a bilateral sensorineural hearing loss as well as a left-sided vestibular areflexia. Follow-up examinations during the next 72 hours showed a rapid progression towards severe sensorineural hearing loss as well as vestibular areflexia in both ears and signs of central vestibular suffering. Magnetic resonance imaging showed disseminated parenchymatous metastases in the brain cortex and the cerebellar hemispheres as well as leptomeningeal dissemination in the posterior fossa with a marked enhancement of the vestibulocochlear nerves in the internal acoustic meati on both sides. The patient was treated by cranial irradiation. He died one week later after a rapid clinical deterioration.