Malignant meningitis secondary to oesophageal adenocarcinoma presenting with sensorineural hearing loss: a series of three cases and discussion of the literature

Abstract

Malignant meningitis may rarely present to the otolaryngologist. We report our experience with 3 patients presenting with sudden, progressive bilateral sensorineural hearing loss secondary to malignant meningitis. The primary tumour in all 3 cases was oesophageal adenocarcinoma. All 3 cases were notable for the rapidity of the patients' clinical deterioration; the interval from presentation to death ranged from 21 to 28 days. We suggest that otolaryngologists should remain vigilant to the possibility of this devastating diagnosis and have a low threshold for further investigation in patients with suspicious features. It is important to note that initial MRI and lumbar puncture may be negative and repeat testing should be undertaken if there is clinical suspicion.

Isolated leptomeningeal carcinomatosis and possible fungal meningitis as late sequelae of oesophageal adenocarcinoma

“…Carcinomatous meningitis is a rare cause of delirium, and recurrence of a solid malignancy as isolated leptomeningeal metastases not visible on imaging is rarer still. Neurological complications resulting from leptomeningeal carcinomatosis secondary to a primary oesophageal cancer have previously been described,4 5 7 but this is the first report of a recurrence presenting in this fashion. A possible mechanism for the development of leptomeningeal metastases without nodal disease could be dural injury and seeding at the time of resection; however, the description of previous similar cases, particularly that described by Lobo et al , which presented with leptomeningeal seeding without any surgical intervention,7 raises the possibility that this could be a natural, rather than iatrogenic, phenomenon.…”

“…Neurological sequelae of oesophageal carcinoma are rare and may be due to cerebral or leptomeningeal metastases and paraneoplastic phenomena. Previous case reports illustrate the primary presentation of oesophageal carcinoma as classic meningitis,4 malignant meningitis causing sensorineural hearing loss,5 limbic encephalitis6 and confusion 7. Recurrence following treatment has also been described presenting with haemorrhagic brain metastasis 8.…”

Clinical Reasoning: A 72-Year-Old Woman With Rapidly Progressive Bilateral Hearing Loss

“…There are several mechanisms by which cancer cells enter the subarachnoid space, including hematogenous spread, direct extension from parenchymal lesions, venous spread from adjacent bony metastasis, or perineural spread. 6 It is commonly seen with lung or breast cancer 6 but has been reported with other solid tumors, 8,9 melanoma and, less commonly, hematologic malignancies. 10…”

Basic Analysis of the Cerebrospinal Fluid: An Important Framework for Laboratory Diagnostics of the Impairment of the Central Nervous System

“…Deep analysis of inflammatory parameters can identify the presence of malignancy in CNS even if tumor cells in the CSF cytology are absent. Elevated proteins, pleiocytosis with predominance of lymphocytes and hypoglycorrhachia are characteristic in CSF patients with malignant infiltration of meninges [ 51 , 53 , 59 , 60 , 61 ].…”