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The patient's dizziness, tinnitus, and hearing loss worsened, and she developed an extreme headache. Lumbar puncture showed cytologic evidence of leptomeningeal metastasis of NSCLC. We conclude, based on the clinical history of a proven stage IV NSCLC, the evidence of leptomeningeal metastasis, and the aspect of the lesions in both IACs, that metastasis in both IACs caused the patient's symptoms. Whole-brain radiotherapy (5 sessions of 4 Gy) and dexamethasone therapy (12 mg/d) were initiated. Gradually, the patient's condition worsened, and because of her unfavorable prognosis, no further diagnostic or therapeutic actions were undertaken. Palliative sedation was administered, and the patient died 1 week later.
Radiology Quiz Case 2: Diagnosis. Arch Otolaryngol Head Neck Surg. 2009;135(7):716-719. doi:10.1001/archoto.2009.59-b