Acoustic neuroma differential diagnosis: Difference between revisions

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{{CMG}}{{AE}}{{Simrat}}
{{CMG}}{{AE}}{{Simrat}}
==Overview==
==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]].<ref name="radio"> Acoustic Schwannoma. Radiopedia(2015) http://radiopaedia.org/articles/acoustic-schwannoma Accessed on October 2 2015</ref>
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]].<ref name="radio">Acoustic Schwannoma. Radiopedia(2015) http://radiopaedia.org/articles/acoustic-schwannoma Accessed on October 2 2015</ref>
==Differential Diagnosis==
==Differential Diagnosis==
Acoustic neuroma must be differentiated from:<ref name="libre">Schwannoma. Librepathology(2015) http://librepathology.org/wiki/index.php/Schwannoma Accessed on October 2 2015</ref>  
Acoustic neuroma must be differentiated from:<ref name="libre">Schwannoma. Librepathology(2015) http://librepathology.org/wiki/index.php/Schwannoma Accessed on October 2 2015</ref>  
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*[[Bell's palsy]]
*[[Bell's palsy]]


Differentiating features of common differential diagnosis are:<ref name="radio"> Acoustic Schwannoma. Radiopedia(2015) http://radiopaedia.org/articles/acoustic-schwannoma Accessed on October 2 2015</ref>
Differentiating features of common differential diagnosis are:<ref name="radio">Acoustic Schwannoma. Radiopedia(2015) http://radiopaedia.org/articles/acoustic-schwannoma Accessed on October 2 2015</ref>
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=== Differential diagnosis for SSNHL: ===
|valign=top|
Since the most common cause of Acoustic Neuroma is hearing loss, the differential diagnosis for SSNHL (Sudden Sensorineural Hearing Loss ) are listed below.
{| style="border: 0px; margin: 3px; font-size: 100%; width: 600px;" align="center"
| valign="top" |
|+
|+
! colspan="4" style="background: #5579FF; width: 600px;" | {{fontcolor|#FFF|Identifiable Causes of Sudden Sensorineural Hearing Loss}}
! colspan="4" style="background: #5579FF; width: 600px;" | {{fontcolor|#FFF|Identifiable Causes of Sudden Sensorineural Hearing Loss}}
|-
|-
! rowspan="4" style="padding: 5px 5px; background: #4169e1; | {{fontcolor|#FFF|Autoimmune}}
! rowspan="4" style="padding: 5px 5px; background: #4169e1; " | {{fontcolor|#FFF|Autoimmune}}
! style="padding: 5px 5px; background: #f0f8ff; | Autoimmune inner ear disease
! style="padding: 5px 5px; background: #f0f8ff; " | Autoimmune inner ear disease
! rowspan="3" style="padding: 5px 5px; background: #4169e1; | {{fontcolor|#FFF|Neurologic}}
! rowspan="3" style="padding: 5px 5px; background: #4169e1; " | {{fontcolor|#FFF|Neurologic}}
! style="padding: 5px 5px; background: #f0f8ff; | Migraine
! style="padding: 5px 5px; background: #f0f8ff; " | Migraine
|-
|-
! style="padding: 5px 5px; background: #f0f8ff; | Behcet’s disease
! style="padding: 5px 5px; background: #f0f8ff; " | Behcet’s disease
! style="padding: 5px 5px; background: #f0f8ff; | Multiple sclerosis
! style="padding: 5px 5px; background: #f0f8ff; " | Multiple sclerosis
|-
|-
! style="padding: 5px 5px; background: #f0f8ff; | Cogan’s syndrome
! style="padding: 5px 5px; background: #f0f8ff; " | Cogan’s syndrome
! style="padding: 5px 5px; background: #f0f8ff; | Pontine ischemia
! style="padding: 5px 5px; background: #f0f8ff; " | Pontine ischemia
|-
|-
! style="padding: 5px 5px; background: #f0f8ff; | Systemic lupus erythematosis
! style="padding: 5px 5px; background: #f0f8ff; " | Systemic lupus erythematosis
! rowspan="4" style="padding: 5px 5px; background: #4169e1; | {{fontcolor|#FFF|Otologic}}
! rowspan="4" style="padding: 5px 5px; background: #4169e1; " | {{fontcolor|#FFF|Otologic}}
! style="padding: 5px 5px; background: #f0f8ff; | Fluctuating hearing loss
! style="padding: 5px 5px; background: #f0f8ff; " | Fluctuating hearing loss
|-
|-
! rowspan="9" style="padding: 5px 5px; background: #4169e1; | {{fontcolor|#FFF|Infectious}}
! rowspan="9" style="padding: 5px 5px; background: #4169e1; " | {{fontcolor|#FFF|Infectious}}
! style="padding: 5px 5px; background: #f0f8ff; | Bacterial Meningitis
! style="padding: 5px 5px; background: #f0f8ff; " | Bacterial Meningitis
! style="padding: 5px 5px; background: #f0f8ff; | Meniere’s disease
! style="padding: 5px 5px; background: #f0f8ff; " | Meniere’s disease
|-
|-
! style="padding: 5px 5px; background: #f0f8ff; | Cryptococcal meningitis
! style="padding: 5px 5px; background: #f0f8ff; " | Cryptococcal meningitis
! style="padding: 5px 5px; background: #f0f8ff; | Otosclerosis
! style="padding: 5px 5px; background: #f0f8ff; " | Otosclerosis
|-
|-
! style="padding: 5px 5px; background: #f0f8ff; | HIV
! style="padding: 5px 5px; background: #f0f8ff; " | HIV
! style="padding: 5px 5px; background: #f0f8ff; | Enlarged vestibular aqueduct
! style="padding: 5px 5px; background: #f0f8ff; " | Enlarged vestibular aqueduct
|-
|-
! style="padding: 5px 5px; background: #f0f8ff; | Lassa fever
! style="padding: 5px 5px; background: #f0f8ff; " | Lassa fever
! rowspan="4" style="padding: 5px 5px; background: #4169e1; | {{fontcolor|#FFF|Toxic}}
! rowspan="4" style="padding: 5px 5px; background: #4169e1; " | {{fontcolor|#FFF|Toxic}}
! style="padding: 5px 5px; background: #f0f8ff; | Aminoglycosides
! style="padding: 5px 5px; background: #f0f8ff; " | Aminoglycosides
|-
|-
! style="padding: 5px 5px; background: #f0f8ff; | Lyme disease
! style="padding: 5px 5px; background: #f0f8ff; " | Lyme disease
! style="padding: 5px 5px; background: #f0f8ff; | Chemotherapeutic agents
! style="padding: 5px 5px; background: #f0f8ff; " | Chemotherapeutic agents
|-
|-
! style="padding: 5px 5px; background: #f0f8ff; | Mumps
! style="padding: 5px 5px; background: #f0f8ff; " | Mumps
! style="padding: 5px 5px; background: #f0f8ff; | Non-steroidal anti-inflammatories
! style="padding: 5px 5px; background: #f0f8ff; " | Non-steroidal anti-inflammatories
|-
|-
! style="padding: 5px 5px; background: #f0f8ff; | Mycoplasma
! style="padding: 5px 5px; background: #f0f8ff; " | Mycoplasma
! style="padding: 5px 5px; background: #f0f8ff; | Salicylates
! style="padding: 5px 5px; background: #f0f8ff; " | Salicylates
|-
|-
! style="padding: 5px 5px; background: #f0f8ff; | Syphilis
! style="padding: 5px 5px; background: #f0f8ff; " | Syphilis
! rowspan="4" style="padding: 5px 5px; background: #4169e1; | {{fontcolor|#FFF|Traumatic}}
! rowspan="4" style="padding: 5px 5px; background: #4169e1; " | {{fontcolor|#FFF|Traumatic}}
! style="padding: 5px 5px; background: #f0f8ff; | Inner ear concussion
! style="padding: 5px 5px; background: #f0f8ff; " | Inner ear concussion
|-
|-
! style="padding: 5px 5px; background: #f0f8ff; | Toxoplasmosis
! style="padding: 5px 5px; background: #f0f8ff; " | Toxoplasmosis
! style="padding: 5px 5px; background: #f0f8ff; | Iatrogenic trauma/surgery
! style="padding: 5px 5px; background: #f0f8ff; " | Iatrogenic trauma/surgery
|-
|-
! rowspan="3" style="padding: 5px 5px; background: #4169e1; | {{fontcolor|#FFF|Vascular}}
! rowspan="3" style="padding: 5px 5px; background: #4169e1; " | {{fontcolor|#FFF|Vascular}}
! style="padding: 5px 5px; background: #f0f8ff; | Cardiovascular bypass
! style="padding: 5px 5px; background: #f0f8ff; " | Cardiovascular bypass
! style="padding: 5px 5px; background: #f0f8ff; | Perilymphatic fistula
! style="padding: 5px 5px; background: #f0f8ff; " | Perilymphatic fistula
|-
|-
! style="padding: 5px 5px; background: #f0f8ff; | Temporal bone fracture
! style="padding: 5px 5px; background: #f0f8ff; " | Temporal bone fracture
! style="padding: 5px 5px; background: #f0f8ff; | Cerebrovascular accident/stroke
! style="padding: 5px 5px; background: #f0f8ff; " | Cerebrovascular accident/stroke
|-
|-
! style="padding: 5px 5px; background: #f0f8ff; | Sickle cell disease
! style="padding: 5px 5px; background: #f0f8ff; " | Sickle cell disease
! rowspan="2" style="padding: 5px 5px; background: #4169e1; | {{fontcolor|#FFF|Metabolic}}
! rowspan="2" style="padding: 5px 5px; background: #4169e1; " | {{fontcolor|#FFF|Metabolic}}
! style="padding: 5px 5px; background: #f0f8ff; | Diabetes mellitus
! style="padding: 5px 5px; background: #f0f8ff; " | Diabetes mellitus
|-
|-
! rowspan="4" style="padding: 5px 5px; background: #4169e1; | {{fontcolor|#FFF|Neoplastic}}
! rowspan="4" style="padding: 5px 5px; background: #4169e1; " | {{fontcolor|#FFF|Neoplastic}}
! style="padding: 5px 5px; background: #ffa500; | Acoustic neuroma
! style="padding: 5px 5px; background: #ffa500; " | Acoustic neuroma
! style="padding: 5px 5px; background: #f0f8ff; | Hypothyroidism
! style="padding: 5px 5px; background: #f0f8ff; " | Hypothyroidism
|-
|-
! style="padding: 5px 5px; background: #f0f8ff; | CPA or petrous meningiomas
! style="padding: 5px 5px; background: #f0f8ff; " | CPA or petrous meningiomas
! rowspan="3" style="padding: 5px 5px; background: #4169e1; | {{fontcolor|#FFF|Functional}}
! rowspan="3" style="padding: 5px 5px; background: #4169e1; " | {{fontcolor|#FFF|Functional}}
! style="padding: 5px 5px; background: #f0f8ff; | Conversion disorder
! style="padding: 5px 5px; background: #f0f8ff; " | Conversion disorder
|-
|-
! style="padding: 5px 5px; background: #f0f8ff; | CPA or petrous apex metastases
! style="padding: 5px 5px; background: #f0f8ff; " | CPA or petrous apex metastases
! rowspan="2" style="padding: 5px 5px; background: #f0f8ff; | Malingering
! rowspan="2" style="padding: 5px 5px; background: #f0f8ff; " | Malingering
|-
|-
! style="padding: 5px 5px; background: #f0f8ff; | CPA myeloma
! style="padding: 5px 5px; background: #f0f8ff; " | CPA myeloma
|-
|-
|}
|}

Revision as of 10:51, 1 June 2018

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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]

Differentiating features of common differential diagnosis are:[1]

Disease/Condition Differentiating Signs/Symptoms Findings on CT or MRI
Meningioma
  • Hearing loss is less common
  • Usually more homogeneous in appearance: significant signal heterogeneity with cystic or haemorrhagic areas is more typical of vestibular schwannoma than meningiomas (although cystic meningiomas do occur)
  • Meningiomas tend to have a broad dural base
  • Usually lack trumpet IAM sign
  • Calcification is more common
Intracranial epidermoid cyst
  • Hearing loss is less common
  • No enhancing component
  • Very high signal on DWI (Diffusion weighted imaging)
  • Does not widen the IAC (Internal auditory canal)
Facial nerve schwannoma
  • Facial weakness is common and occurs early
  • Sometimes associated with neurofibromatosis
  • CT and MRI imaging results are similar to acoustic neuroma but enhancement extends into the geniculate ganglion of the facial nerve and facial canal
Trigeminal schwannoma
  • Clinically associated with facial numbness
  • Hearing loss is less common
  • CT and MRI imaging displays a dumbbell-shaped mass over the petrous apex affecting Meckel cave.
  • The trigeminal nerve enhancement extends proximal to the tumor and does not extend into the IAM (internal acoustic meatus)

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.

Identifiable Causes of Sudden Sensorineural Hearing Loss
Autoimmune Autoimmune inner ear disease 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

References

  1. ↑ 1.0 1.1 Acoustic Schwannoma. Radiopedia(2015) http://radiopaedia.org/articles/acoustic-schwannoma Accessed on October 2 2015
  2. ↑ Schwannoma. Librepathology(2015) http://librepathology.org/wiki/index.php/Schwannoma 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.

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