Acoustic neuroma (vestibular Schwannoma) – What are the signs and symptoms, relevant dDx., sequelae, work up, and treatment options?

January 6, 2021 5:24 am Published by

An acoustic neuroma (vestibular Schwannoma) is a benign tumor of the vestibular division of cranial nerve VIII. It starts in the internal auditory canal and expands into the cerebellopontine angle, compressing the cerebellum and brainstem, and can affect cranial nerves V and VII. Acoustic neuroma is the most common cause of sensorineural hearing loss and is associated with neurofibromatosis type II.

Sn. & Sx.:

  • Headache
  • Unilateral sensorineural hearing loss
  • Tinnitus
  • Nystagmus
  • Prgressive dizziness
  • Loss of balance and coordination
  • Diplopia on lateral gaze
  • Facial numbness, weakness
  • Increased intracranial pressure
  • Papilledema

dDx.:

  • Benign paroxysmal positional vertigo
  • Cholesteatoma
  • Meningioma
  • Meniere’s disease
  • Vestibular neuronitis
  • Labyrinthitis
  • Ototoxic drugs

Sequelae:

  • Facial nerve palsy and trigeminal sensory deficit (corneal reflex)

Work up:

  • Imaging (MRI, CT)
  • Absent stapedial reflex

Tx.:

  • Surgical excision

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This post was written by Omar Rifai