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]
Overview
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]
- Meningioma
- Intracranial epidermoid cyst
- Facial nerve schwannoma
- Trigeminal schwannoma
- Ependymoma
- Metastasis
- Leiomyoma
- Intranodal palisaded myofibroblastoma
- Gastrointestinal stromal tumor
- MPNST - schwannoma with ancient change has no significant mitotic activity[3]
- Neurofibroma
- Meniere's disease
- Bell's palsy
Differentiating features of common differential diagnosis are:[1]
| Differentiating features of common differential diagnosis | ||
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| Disease/Condition | Differentiating Signs/Symptoms | Findings on CT or MRI |
| Meningioma |
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| Intracranial epidermoid cyst |
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| Facial nerve schwannoma |
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| Trigeminal schwannoma |
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Differential diagnosis for SSNHL:
Since the most common cause of Acoustic Neuroma is hearing loss, the differential diagnosis for SSNHL (Sudden Sensorineural Hearing Loss ) are listed below.[4]
| Identifiable Causes of Sudden Sensorineural Hearing Loss | |||
|---|---|---|---|
| Autoimmune | Autoimmune inner ear disease | fontcolor|#FFF|Neurologic | Migraine |
| Behcet’s disease | Multiple sclerosis | ||
| Cogan’s syndrome | Pontine ischemia | ||
| Systemic lupus erythematosis | Otologic | Fluctuating hearing loss | |
| Infectious | Bacterial Meningitis | Meniere’s disease | |
| Cryptococcal meningitis | Otosclerosis | ||
| HIV | Enlarged vestibular aqueduct | ||
| Lassa fever | Toxic | Aminoglycosides | |
| Lyme disease | Chemotherapeutic agents | ||
| Mumps | Non-steroidal anti-inflammatories | ||
| Mycoplasma | 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 | |
| CPA or petrous meningiomas | Functional | Conversion disorder | |
| CPA or petrous apex metastases | Malingering | ||
| CPA myeloma | |||
Differentiating Acoustic Neuroma from Meningioma in CT Scans
The most important differential diagnosis for Acoustic neuroma is Meningioma of Pontine angle, so it is vital to distinguish these two diseases. As you see below this diagram demonstrate this differences of these two disease in CT Scan.[5]
| <13cm3 | Volume | >35cm3 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No | Increased attenuation | Yes | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No | Marked calcification | Yes | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No | Oval shape | Yes | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Yes | Round shape | Mostly No | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Acoustic Neuroma | No | Tumor reaches dorsum sellae anteriorly | Yes | Meningioma | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Mostly No | Apparently broad attachment to bone | Yes | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No | Center of tumor anterior to porus | Sometimes Yes | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No | Tumor reaches > 2 cm above dorsum | Mostly Yes | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Sometimes | Peripheral edema | No | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Mostly Yes | Widening of porus or other bone changes | No | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
References
- ↑ 1.0 1.1 Acoustic Schwannoma. Radiopedia(2015) http://radiopaedia.org/articles/acoustic-schwannoma Accessed on October 2 2015
- ↑ Schwannoma. Librepathology(2015) http://librepathology.org/wiki/index.php/Schwannoma Accessed on October 2 2015
- ↑ 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.
- ↑ 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.
- ↑ A. M611er, A. Hatam and H. Olivecrona (1978). "The Differential Diagnosis of Pontine Angle Meningioma and Acoustic Neuroma with Computed Tomography". Neuroradilogy.