A case of lung adenocarcinoma with meningeal carcinomatosis presenting with bilateral hearing loss and left facial nerve palsy

Background. Meningeal carcinomatosis is a poor prognostic state which sometimes diagnosed in patients with advanced cancer, and shows varied neurological symptoms not limited to those of typical meningitis. It is sometimes hard to establish an accurate diagnosis because an identifiable mass lesion is not always visible on radiological examination. Case. A 56-year-old Japanese man underwent left lower lobectomy and adjuvant chemotherapy for treatment of stage IIIA lung adenocarcinoma. Nine months postoperatively, he experienced right hearing loss, followed by left facial nerve palsy. Eleven months postoperatively, he was admitted to hospital because of progressive left hearing loss, temporary loss of consciousness, amnesia, incontinence, and other symptoms. A tiny metastatic lesion was found on the brain surface of the temporal lobe on cranial MRI. His cerebrospinal fluid was examined, and a diagnosis of meningeal carcinomatosis was established. He deteriorated rapidly and died 13 months postoperatively. Conclusion. This report describes a rare case of meningeal carcinomatosis diagnosed by clinical course, cranial MRI findings, and biochemical examination of the cerebrospinal fluid, showing a variety of neurological symptoms, including hearing loss and facial nerve palsy, without distant metastases to other organs.