Naslov
Vertigo with hearing loss as the first symptom of leptomeningeal carcinomatosis originating from colorectal carcinoma.

Autori
Bokun, Hana ; Marčinko, Anita ; Budinčević, Hrvoje ; Bielen, Ivan.

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, stručni

Izvornik
Acta Neuropsychiatrica 21 (Suppl 2) / - , 2009, 82-83

Skup
49th International Neuropsychiatric Pula Congress

Mjesto i datum
Pula, Hrvatska, 17.06.2009. - 20.06.2009

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
vertigo. hearing loss; leptomeningeal carcinomatosis.

Sažetak
Introduction Leptomeninges are common dissemination site of advanced malignant disease. The most frequent primary sites are breast, lung, melanoma and stomach, whereas colon is rarely reported. Case report We report a case of a 70- year-old man who was admitted to the neurology department with a three-week history of mild frontal headache, vertigo and vomiting. The patient had no history of malignancies or any other serious diseases. The neurological examination showed an ataxic gate and hearing loss on the right ear. Findings of the multi-slice computed tomography (MSCT) of the brain were unremarkable. Magnetic resonance imaging (MRI) of the brain showed multiple periventricular white matter lesions. During the next few days the patient symptoms progressed to include right peripheral facial nerve palsy, complete hearing loss and mental alteration. Body temperature and inflammation parameters were normal all of this time. Gadolinium-enhanced MRI was performed and revealed diffuse leptomeningeal enhancement of the cranial base a thickening of both of the vestibulocochlear nerves especially right one. Cerebrospinal fluid (CSF) analysis showed sterile hypercellular (1184/3mm3) CSF with predominantly low-differentiated malignant cells with numerous mitoses (Figure 1), hypoglycorrhachia (1, 7 mmol/L) and elevated protein level. The highly increased serum levels of the tumor marker carbohydrate antigen 19-9 was present. Ultrasound and MSCT of the abdomen, esophagogastroduodenoscopy as well as ultrasound of the thyroid gland and chest X-ray did not find any signs of malignant disease. However, colonoscopy revealed an infiltrating process that prominates to the lumen of the ascending colon. The patient showed no symptoms of intestinal obstruction or any other GI tract symptoms. Histopatological analysis of biopsy samples verified adenocarcinoma. The patient refused intratecal chemotherapy and underwent whole-brain radiotherapy. Despite treatment, the patient’s state deteriorated and as a result he died shortly after. Conclusion Unilateral hearing loss progressing to bilateral deafness within short period of time is a rare clinical manifestation of the leptomeningeal carinomatosis.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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