Successful treatment of a patient with leptomeningeal carcinomatosis-induced balance disorder

A 79-year-old man who was treated for malignant lymphoma presented with a history of dizziness and right ear fullness since February 2019. He developed right facial nerve palsy and visited our hospital a week later. At the time of his first consultation, his facial nerve palsy score was 4 points, according to the Yanagihara grading system, and a hearing test revealed acute right-sided mixed hearing loss. Temporal bone computed tomography revealed no obvious abnormalities, and magnetic resonance imaging revealed contrast findings enhancement in the bilateral internal auditory canals. He received a 10-day course of steroid infusion as treatment for the facial nerve palsy and acute sensorineural hearing loss. He developed dizziness and gait disorder 11 days after discharge. Cerebrospinal fluid cytology revealed central nervous system invasion by the malignant lymphoma. Caloric testing revealed bilateral loss of vestibular function. He was treated with whole-brain irradiation and intrathecal methotrexate injection three times. Post-treatment caloric testing revealed recovery of the left-sided vestibular function. Unfortunately, the patient died of progressive disease 7 months later. Whole-brain radiotherapy and intrathecal injections of anticancer drugs serve as useful palliative treatment for leptomeningeal carcinomatosis-induced balance disorder, particularly in patients with malignant lymphoma.