A case of palsies of oculomotor and vestibulocochlear nerves as a first sign of lung adenocarcinoma accompanied with metastatic leptomeningeal carcinomatosis

Abstract

Background. Multiple cranial neuropathies as the first sign of onset due to metastatic leptomeningeal carcinomatosis is very rare. Case. An 89-year-old man experienced a loss of hearing in the left ear in autumn of 2007. In January 2008, a droop in the right eyelid and ache in the eye appeared suddenly. He was referred and admitted to the department of neurosurgery in our hospital, where an old cerebral infarction was diagnosed on brain magnetic resonance imaging. The drooping right eyelid progressed and a right ocular movement disorder developed. He was treated for Tolosa-Hunt syndrome with corticosteroid. Soon thereafter, his symptoms worsened and gadolinium-enhanced brain MRI revealed that there were multiple nodular foci with contrasting enhancement along the right oculomotor and left vestibulocochlear nerves, suggesting a diagnosis of metastatic leptomeningeal carcinomatosis. A final diagnosis was given of lung adenocarcinoma of the left lower lung (S8), cT4N2M1b, stage IV, by chest CT scan and sputum cytology. The patient underwent whole-brain radiotherapy (30 Gy) and subsequent systemic chemotherapy (carboplatin + paclitaxel), which proved to be ineffective. Thereafter, left facial palsy and glossopharyngeal nerve disorder and consciousness disturbance developed and gradually progressed. His neurological symptoms worsened and the patient eventually died in May. Conclusion. We reviewed the detailed clinical features and discussed a case of metastatic leptomeningeal carcinomatosis with cranial neuropathy as the first sign of onset. © 2011 The Japan Lung Cancer Society.