Acoustic neuroma differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2], Arash Azhideh,


Acoustic neuroma must be differentiated from meningioma, intracranial epidermoid cyst, facial nerve schwannoma, trigeminal schwannoma, ependymoma, leiomyoma, intranodal palisaded myofibroblastoma, malignant peripheral nerve sheath tumour (MPNST), gastrointestinal stromal tumor, neurofibroma, Meniere's disease, and Bell's palsy.[1]

Differential Diagnosis

Acoustic neuroma must be differentiated from:[2]

Differentiating features of common differential diagnoses are:[1]

Differentiating features of common differential diagnosis
Disease/Condition Differentiating Signs/Symptoms Findings on CT or MRI
Intracranial epidermoid cyst
  • No enhancing component
  • Very high signal on DWI (Diffusion weighted imaging)
  • Does not widen the internal auditory canal
Facial nerve schwannoma
Trigeminal schwannoma

Differential diagnosis for SSNHL:

Since the most common outcome of acoustic aeuroma is hearing loss, the differential diagnoses for SSNHL (Sudden Sensorineural Hearing Loss ) are listed below.[4]

Identifiable Causes of Sudden Sensorineural Hearing Loss
Autoimmune Autoimmune inner ear disease Neurologic Migraine
Behcet’s disease Multiple sclerosis
Cogan syndrome Pontine ischemia
Systemic lupus erythematosis Otologic Fluctuating hearing loss
Infectious Bacterial Meningitis Meniere’s disease
Cryptococcal meningitis Otosclerosis
HIV AIDS Enlarged vestibular aqueduct
Lassa fever Toxic Aminoglycosides
Lyme disease Chemotherapeutic agents
Mumps Non-steroidal anti-inflammatory drugs
Mycoplasma infection Salicylates
Syphilis Traumatic Inner ear concussion
Toxoplasmosis Iatrogenic trauma/surgery
Vascular Cardiovascular bypass Perilymphatic fistula
Temporal bone fracture Cerebrovascular accident/stroke
Sickle cell disease Metabolic Diabetes mellitus
Neoplastic Acoustic neuroma Hypothyroidism
Cerebellopontine angle or petrous meningiomas Functional Conversion disorder
Cerebellopontine angle or petrous apex metastases Malingering
Cerebellopontine angle myeloma

Differentiating Acoustic Neuroma from Meningioma in CT Scans

The most important differential diagnosis of acoustic neuroma is meningioma of the pontine angle. Below given diagram demonstrates the difference between acoustic neuroma and meningioma of the pontine angle based on CT scan findings:[5]

Increased attenuation
Marked calcification
Oval shape
Round shape
Mostly No
Acoustic Neuroma
Tumor reaches dorsum sellae anteriorly
Mostly No
Apparently broad attachment to bone
Center of tumor anterior to porus
Sometimes Yes
Tumor reaches > 2 cm above dorsum
Mostly Yes
Peripheral edema
Mostly Yes
Widening of porus or other bone changes


  1. 1.0 1.1 Acoustic Schwannoma. Radiopedia(2015) Accessed on October 2 2015
  2. Schwannoma. Librepathology(2015) Accessed on October 2 2015
  3. Chan PT, Tripathi S, Low SE, Robinson LQ (2007). "Case report--ancient schwannoma of the scrotum". BMC Urol. 7: 1. doi:10.1186/1471-2490-7-1. PMC 1783662. PMID 17244372.
  4. Maggie Kuhn, MD, Selena E. Heman-Ackah, MD, MBA, Jamil A. Shaikh, BA, and Pamela C. Roehm, MD, PhD (2011). "Sudden Sensorineural Hearing Loss: A Review of Diagnosis, Treatment, and Prognosis". Sagepub.
  5. A. M611er, A. Hatam and H. Olivecrona (1978). "The Differential Diagnosis of Pontine Angle Meningioma and Acoustic Neuroma with Computed Tomography". Neuroradilogy.