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Vestibular Schwannoma

Williams LLW - MedPix (2011)

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Vestibular Schwannoma

History: 54 yo woman presents for evaluation of ringing in left ear over a month. Pt reports high-pitched, non-pulsatile tinnitus that initially was constant for two weeks. She then had a period of 2-3 weeks where she was asymptomatic. Tinnitus has now returned, worse in the morning and lasts for 2-3 hours, then is intermittent throughout the day. Pt denies ear fullness, hearing loss, vertigo, or nausea/vomiting. No history of trauma, stroke, or noise exposure. Reports vague history of light headedness and balance problem (not vertigo), which she was referred to be seen by outside neurologist but has not followed-up on. Had audiogram done which is essentially normal.

Findings: There is an ill-defined mass lesion, 1cm long, within the left porus acusticus (internal auditory canal) with minimal extension into the left superior pontine cistern measuring .

Ddx: • vestibular Schwanomma • glomus tumor • meningionma

Dxhow: MRI T1W

Exam: BP: 139/92, HR: 72, RR: 16, T: 98.3 °F, HT: 60 in, WT: 100 lbs, BMI: 19.53, BSA: 1.39 square meters, Physical findings General: Well appearing, no acute distress. Head: ATNC Neck: No swelling, soft, supple. Eyes: Extraocular Movements with normal gaze, smooth pursuit, and saccades. No nystagmus following Dix-Hallpike maneuvers. PERRLA Ears: General/bilateral: External Auditory Canal: ° External auditory meatus without discharge or deformity. TM intact. No effusions. No retractions of the pars flaccida or pars tensa. Positve LR, LS, mobility and negative erythema, bulging. Hearing: Weber's test abnormal lateralized to right. Rinne's test AC>BC bilaterally. Reception threshold normal grossly normal to speech and whispered voice. Nose: General/bilateral: Nasal Discharge: ° No nasal discharge. No external nose deformities. No sinus tenderness. Nasal/Oral mucosa patent and moist mucous membranes without ulceration, deformities or lesions. Lymph Nodes: ° Cervical lymph nodes were not enlarged. ° Preauricular lymph nodes were not enlarged. ° Postauricular lymph nodes were not enlarged. ° Suboccipital lymph nodes were not enlarged. Neurological: CNII-XII grossly intact. Sensation positional/vibratory/light touch intact b/l in u/l extremities. Motor 5+ b/l in u/l extremities. No dysdiadochokinesia, dysmetria. Gait And Stance normal. Reflexes 2+ patellar and brachioradialis.

No MeSH data available.


There is a 1 cm diameter enhancing lesion, left internal auditory canal.
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MPX2026_synpic55847: There is a 1 cm diameter enhancing lesion, left internal auditory canal.


Vestibular Schwannoma

Williams LLW - MedPix (2011)

There is a 1 cm diameter enhancing lesion, left internal auditory canal.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX2026&req=5

MPX2026_synpic55847: There is a 1 cm diameter enhancing lesion, left internal auditory canal.

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Vestibular Schwannoma

History: 54 yo woman presents for evaluation of ringing in left ear over a month. Pt reports high-pitched, non-pulsatile tinnitus that initially was constant for two weeks. She then had a period of 2-3 weeks where she was asymptomatic. Tinnitus has now returned, worse in the morning and lasts for 2-3 hours, then is intermittent throughout the day. Pt denies ear fullness, hearing loss, vertigo, or nausea/vomiting. No history of trauma, stroke, or noise exposure. Reports vague history of light headedness and balance problem (not vertigo), which she was referred to be seen by outside neurologist but has not followed-up on. Had audiogram done which is essentially normal.

Findings: There is an ill-defined mass lesion, 1cm long, within the left porus acusticus (internal auditory canal) with minimal extension into the left superior pontine cistern measuring .

Ddx: • vestibular Schwanomma • glomus tumor • meningionma

Dxhow: MRI T1W

Exam: BP: 139/92, HR: 72, RR: 16, T: 98.3 °F, HT: 60 in, WT: 100 lbs, BMI: 19.53, BSA: 1.39 square meters, Physical findings General: Well appearing, no acute distress. Head: ATNC Neck: No swelling, soft, supple. Eyes: Extraocular Movements with normal gaze, smooth pursuit, and saccades. No nystagmus following Dix-Hallpike maneuvers. PERRLA Ears: General/bilateral: External Auditory Canal: ° External auditory meatus without discharge or deformity. TM intact. No effusions. No retractions of the pars flaccida or pars tensa. Positve LR, LS, mobility and negative erythema, bulging. Hearing: Weber's test abnormal lateralized to right. Rinne's test AC>BC bilaterally. Reception threshold normal grossly normal to speech and whispered voice. Nose: General/bilateral: Nasal Discharge: ° No nasal discharge. No external nose deformities. No sinus tenderness. Nasal/Oral mucosa patent and moist mucous membranes without ulceration, deformities or lesions. Lymph Nodes: ° Cervical lymph nodes were not enlarged. ° Preauricular lymph nodes were not enlarged. ° Postauricular lymph nodes were not enlarged. ° Suboccipital lymph nodes were not enlarged. Neurological: CNII-XII grossly intact. Sensation positional/vibratory/light touch intact b/l in u/l extremities. Motor 5+ b/l in u/l extremities. No dysdiadochokinesia, dysmetria. Gait And Stance normal. Reflexes 2+ patellar and brachioradialis.

No MeSH data available.