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A 44-year-old women presented with a 2-day history of a sudden onset of rotatory vertigo, left-sided hearing loss, nausea, and vomiting. Three months earlier, she had been diagnosed as having stage IV non–small cell lung carcinoma (NSCLC), for which she underwent chemotherapy. None of the medications she used was registered as having otovestibular toxic effects. There was no other notable medical or family history. The findings of otoscopy and facial nerve function were normal. Further neuro-otologic examination revealed no abnormalities. Pure-tone audiometry showed bilateral sensorineurinal hearing loss with an extended Fletcher index (average hearing losses at 0.5, 1, 2, and 4 kHz) of 25 dB in the right ear and 30 dB in the left ear. Laboratory assessment for neurotropic viruses showed no signs of recent infection or viral reactivation.
van de Langenberg R, Stokroos R, de Bondt B. Radiology Quiz Case 2. Arch Otolaryngol Head Neck Surg. 2009;135(7):716-719. doi:10.1001/archoto.2009.59-a