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.