Isolated acute hearing loss as the presenting symptom of leptomeningeal carcinomatosis.

Leptomeningeal carcinomatosis is characterized by diffuse infiltration of the meninges by metastatic cancer. We report a rare case of leptomeningeal carcinomatosis with an initial presentation of isolated acute hearing loss. Progressive unsteady gait and multiple cranial nerve palsies ensued. Computed tomography of the chest with contrast revealed a 2 cm nodule over the right upper lung. Cytology of cerebrospinal fluid confirmed the diagnosis of adenocarcinoma. The patient was discharged after diagnosis. Isolated acute hearing loss is a rare initial presentation in leptomeningeal carcinomatosis, not necessarily with a known history of malignancy. A high index of suspicion is mandatory for accurate diagnosis.