Introduction
Neoplastic meningitis, also known as leptomeningeal carcinomatosis or
carcinomatous meningitis, occurs due to metastatic spread to the
arachnoid and/or pia mater. It is associated with both hematological and
solid malignancies and its incidence is increasing.1Whether this actually represents increasing recognition remains
uncertain. The associated meningeal inflammation can lead to a wide
variety of clinical presentations making diagnosis challenging. Previous
case reports have detailed a range of clinical features including
headache, altered mental status, and visual disturbances, often
requiring repeated review prior to the eventual correct diagnosis of
neoplastic meningitis being made.2-4 This case
highlights another manifestation, namely dizziness, which was initially
attributed to a diagnosis of Benign Paroxysmal Positional Vertigo
(BPPV).
Although the prognosis of neoplastic meningitis is poor, early
recognition and aggressive treatment can increase life
expectancy.5 It is therefore important that clinicians
are reminded of the varied presentations and the cardinal investigative
findings that help make the diagnosis. Furthermore, this case hopes to
serve as a reminder of the diagnostic challenge recurrent attenders
present, and the risk of missing evolving symptoms due to fixation on
initial diagnoses.