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Updated: Oct 4, 2025
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Neuro-rehabilitation Approach for Sudden Sensorineural Hearing Loss
Published on: January 25, 2016
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Clinical Reasoning: A 72-Year-Old Woman With Rapidly Progressive Bilateral Hearing Loss
Aseel Alsalem1, Sina Marzoughi1, Tychicus Chen1
1From the University of British Columbia, Vancouver, Canada.
Neurology
|February 11, 2022
Summary
Rapidly progressive sensorineural hearing loss (SNHL) in a 72-year-old woman was the initial sign of metastatic breast cancer. This case underscores the importance of investigating central causes for sudden hearing deficits.
Area of Science:
- Neurology
- Oncology
- Otolaryngology
Background:
- Sensorineural hearing loss (SNHL) can present with diverse etiologies.
- Neuropsychiatric symptoms can sometimes accompany neurological disorders.
Observation:
- A 72-year-old woman experienced rapid SNHL and neuropsychiatric changes.
- Cerebrospinal fluid (CSF) analysis showed elevated protein, low glucose, and malignant cells.
- Brain MRI revealed bilateral internal auditory canal and left cochlear enhancement.
- Zic4 antibodies were detected in serum and CSF.
- Biopsy confirmed poorly differentiated breast adenocarcinoma metastatic to the leptomeninges.
Findings:
- Metastatic breast adenocarcinoma presenting as leptomeningeal carcinomatosis.
- Rapidly progressive SNHL as the primary presenting symptom.
- Treatment with intrathecal methotrexate was ineffective for hearing symptoms.
Implications:
- Highlights the necessity of considering central nervous system malignancy in cases of unexplained, rapidly progressive SNHL.
- Emphasizes the role of comprehensive diagnostic workups, including neuroimaging and CSF analysis, for atypical neurological presentations.
- Suggests that leptomeningeal carcinomatosis can manifest initially with auditory and neuropsychiatric symptoms.
