Imbalance, Progressive Hearing Loss, and Diplopia: Making Sense of Multifocal Neurologic Disease

Multifocal cranial neuropathy can be associated with infectious, autoimmune, inflammatory, infiltrative, and malignant disease processes. Leptomeningeal carcinomatosis is an uncommon presentation of metastatic cancer that can cause multifocal cranial neuropathy with cerebellar dysfunction as in this case. This case report describes the presentation, workup, and disease course of a 69-year-old woman with leptomeningeal carcinomatosis. She presented with progressive imbalance, progressive hearing loss, and diplopia and was found to have leptomeningeal carcinomatosis from gallbladder cancer.