Case Report: Bilateral vestibulopathy associated with leptomeningeal metastasis
- 1Department of Neurology, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine
Abstract
Introduction: Bilateral vestibulopathy (BVP) presents with oscillopsia, unsteadiness, and imbalance. Leptomeningeal metastasis (LM) is a rare and underrecognized cause of BVP, with direct infiltration of the vestibulocochlear nerves representing a potential mechanism of bilateral vestibular dysfunction. We report a case of LM-related BVP documented by quantitative video head impulse test (vHIT) of all six semicircular canals.
Case report: A 61-year-old man presented with a six-month history of dizziness, tinnitus, oscillopsia, imbalance, and bilateral sensorineural hearing loss. vHIT showed reduced vestibulo-ocular reflex gain in all six semicircular canals. Contrast-enhanced MRI revealed leptomeningeal enhancement and enhancement of both vestibulocochlear nerves. CSF showed elevated protein, lymphocytic pleocytosis, and malignant cells. Serum anti-AQP4 antibodies were positive (1:320), but no other paraneoplastic antibodies were identified. He was diagnosed with LM from lung adenocarcinoma causing secondary BVP via direct infiltration of the vestibulocochlear nerves. Dizziness improved with intrathecal chemotherapy. However, he died approximately one year after discharge.
Conclusion: BVP may be the initial presentation of LM. It underscores the necessity of considering rare etiologies in patients with unexplained BVP. Early recognition and targeted therapy may improve neurological outcomes, although overall prognosis remains limited in the setting of disseminated malignancy.
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BibTeX
@article{feng2026case,
title = {{Case Report: Bilateral vestibulopathy associated with leptomeningeal metastasis}},
author = {Danyu Feng and Wan Wei and Shuqi Hu and Xiaoqin Hong},
journal = {Frontiers in Oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1981680},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1981680/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Case Report: Bilateral vestibulopathy associated with leptomeningeal metastasis
AU - Danyu Feng
AU - Wan Wei
AU - Shuqi Hu
AU - Xiaoqin Hong
PY - 2026
DA - 2026/10/20
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1981680
UR - https://www.frontiersin.org/articles/10.3389/fonc.2026.1981680/full
AB - Introduction: Bilateral vestibulopathy (BVP) presents with oscillopsia, unsteadiness, and imbalance. Leptomeningeal metastasis (LM) is a rare and underrecognized cause of BVP, with direct infiltration of the vestibulocochlear nerves representing a potential mechanism of bilateral vestibular dysfunction. We report a case of LM-related BVP documented by quantitative video head impulse test (vHIT) of all six semicircular canals. Case report: A 61-year-old man presented with a six-month history of dizziness, tinnitus, oscillopsia, imbalance, and bilateral sensorineural hearing loss. vHIT showed reduced vestibulo-ocular reflex gain in all six semicircular canals. Contrast-enhanced MRI revealed leptomeningeal enhancement and enhancement of both vestibulocochlear nerves. CSF showed elevated protein, lymphocytic pleocytosis, and malignant cells. Serum anti-AQP4 antibodies were positive (1:320), but no other paraneoplastic antibodies were identified. He was diagnosed with LM from lung adenocarcinoma causing secondary BVP via direct infiltration of the vestibulocochlear nerves. Dizziness improved with intrathecal chemotherapy. However, he died approximately one year after discharge. Conclusion: BVP may be the initial presentation of LM. It underscores the necessity of considering rare etiologies in patients with unexplained BVP. Early recognition and targeted therapy may improve neurological outcomes, although overall prognosis remains limited in the setting of disseminated malignancy.
SN - 2234-943X
ER -