Acoustic neuroma differential diagnosis: Difference between revisions
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! colspan="3" style="background: #5579FF; width:200;" | {{fontcolor|#FFF|Differentiating features of common differential diagnosis}} | ! colspan="3" style="background: #5579FF; width:200;" | {{fontcolor|#FFF|Differentiating features of common differential diagnosis}} | ||
|- | |- | ||
! style="background: # | ! style="background: #4682B4; width: 200px;" | {{fontcolor|#FFF|Disease/Condition}} | ||
! style="background: # | ! style="background: #4682B4; width: 200px;" | {{fontcolor|#FFF|Differentiating Signs/Symptoms }} | ||
! style="background: # | ! style="background: #4682B4; width: 200px;" | {{fontcolor|#FFF|Findings on CT or MRI}} | ||
|- | |- | ||
! style="padding: 5px 5px; background: #87CEFA; font-weight: bold" | Meningioma | |||
| style="padding: 5px 5px; background: # | | style="padding: 5px 5px; background: #f0f8ff;" | | ||
*Hearing loss is less common | *Hearing loss is less common | ||
| style="padding: 5px 5px; background: # | | style="padding: 5px 5px; background: #f0f8ff;" | | ||
*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) | *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 | *Meningiomas tend to have a broad dural base | ||
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*Calcification is more common | *Calcification is more common | ||
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! style="padding: 5px 5px; background: #87CEFA; font-weight: bold" | Intracranial epidermoid cyst | |||
| style="padding: 5px 5px; background: # | | style="padding: 5px 5px; background: #f0f8ff;" | | ||
*Hearing loss is less common | *Hearing loss is less common | ||
| style="padding: 5px 5px; background: # | | style="padding: 5px 5px; background: #f0f8ff;" | | ||
*No enhancing component | *No enhancing component | ||
*Very high signal on DWI (Diffusion weighted imaging) | *Very high signal on DWI (Diffusion weighted imaging) | ||
*Does not widen the IAC (Internal auditory canal) | *Does not widen the IAC (Internal auditory canal) | ||
|- | |- | ||
! style="padding: 5px 5px; background: #87CEFA; font-weight: bold" | Facial nerve schwannoma | |||
| style="padding: 5px 5px; background: # | | style="padding: 5px 5px; background: #f0f8ff;" | | ||
*Facial weakness is common and occurs early | *Facial weakness is common and occurs early | ||
*Sometimes associated with neurofibromatosis | *Sometimes associated with neurofibromatosis | ||
| style="padding: 5px 5px; background: # | | style="padding: 5px 5px; background: #f0f8ff;" | | ||
*CT and MRI imaging results are similar to acoustic neuroma but enhancement extends into the geniculate ganglion of the facial nerve and facial canal | *CT and MRI imaging results are similar to acoustic neuroma but enhancement extends into the geniculate ganglion of the facial nerve and facial canal | ||
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! style="padding: 5px 5px; background: #87CEFA; font-weight: bold" | Trigeminal schwannoma | |||
| style="padding: 5px 5px; background: # | | style="padding: 5px 5px; background: #f0f8ff;" | | ||
*Clinically associated with facial numbness | *Clinically associated with facial numbness | ||
*Hearing loss is less common | *Hearing loss is less common | ||
| style="padding: 5px 5px; background: # | | style="padding: 5px 5px; background: #f0f8ff;" | | ||
*CT and MRI imaging displays a dumbbell-shaped mass over the petrous apex affecting Meckel cave. | *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) | *The trigeminal nerve enhancement extends proximal to the tumor and does not extend into the IAM (internal acoustic meatus) | ||
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=== Differential diagnosis for SSNHL: === | === 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.<ref>{{Cite journal|last=Maggie Kuhn, MD, Selena E. Heman-Ackah, MD, MBA, Jamil A. Shaikh, BA, and Pamela C. Roehm, MD, PhD|first=|date=2011|title=Sudden Sensorineural Hearing Loss: A Review of Diagnosis, Treatment, and Prognosis|url=|journal=Sagepub|volume=|pages=|via=}}</ref> | Since the most common cause of Acoustic Neuroma is hearing loss, the differential diagnosis for SSNHL (Sudden Sensorineural Hearing Loss ) are listed below.<ref>{{Cite journal|last=Maggie Kuhn, MD, Selena E. Heman-Ackah, MD, MBA, Jamil A. Shaikh, BA, and Pamela C. Roehm, MD, PhD|first=|date=2011|title=Sudden Sensorineural Hearing Loss: A Review of Diagnosis, Treatment, and Prognosis|url=|journal=Sagepub|volume=|pages=|via=}}</ref> | ||
{| style="border: 0px; margin: 3px; font-size: | {| style="border: 0px; margin: 3px; font-size: 90%; width: 600px;" align="center" | ||
| valign="top" | | | 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}} | ||
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! rowspan="4" style="padding: 5px 5px; background: # | ! rowspan="4" style="padding: 5px 5px; background: #87CEFA; " | 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: # | ! rowspan="3" style="padding: 5px 5px; background: #87CEFA; " | fontcolor|#FFF|Neurologic | ||
! style="padding: 5px 5px; background: #f0f8ff; " | Migraine | ! style="padding: 5px 5px; background: #f0f8ff; " | Migraine | ||
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! 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: # | ! rowspan="4" style="padding: 5px 5px; background: #87CEFA; " | {{fontcolor|#FFF|Otologic}} | ||
! style="padding: 5px 5px; background: #f0f8ff; " | Fluctuating hearing loss | ! style="padding: 5px 5px; background: #f0f8ff; " | Fluctuating hearing loss | ||
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! rowspan="9" style="padding: 5px 5px; background: # | ! rowspan="9" style="padding: 5px 5px; background: #87CEFA; " | 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 | ||
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! style="padding: 5px 5px; background: #f0f8ff; " | Lassa fever | ! style="padding: 5px 5px; background: #f0f8ff; " | Lassa fever | ||
! rowspan="4" style="padding: 5px 5px; background: # | ! rowspan="4" style="padding: 5px 5px; background: #87CEFA; " | Toxic | ||
! style="padding: 5px 5px; background: #f0f8ff; " | Aminoglycosides | ! style="padding: 5px 5px; background: #f0f8ff; " | Aminoglycosides | ||
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! style="padding: 5px 5px; background: #f0f8ff; " | Syphilis | ! style="padding: 5px 5px; background: #f0f8ff; " | Syphilis | ||
! rowspan="4" style="padding: 5px 5px; background: # | ! rowspan="4" style="padding: 5px 5px; background: #87CEFA; " | Traumatic | ||
! style="padding: 5px 5px; background: #f0f8ff; " | Inner ear concussion | ! style="padding: 5px 5px; background: #f0f8ff; " | Inner ear concussion | ||
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! 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: # | ! rowspan="3" style="padding: 5px 5px; background: #87CEFA; " | 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 | ||
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! 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: # | ! rowspan="2" style="padding: 5px 5px; background: #87CEFA; " | Metabolic | ||
! style="padding: 5px 5px; background: #f0f8ff; " | Diabetes mellitus | ! style="padding: 5px 5px; background: #f0f8ff; " | Diabetes mellitus | ||
|- | |- | ||
! rowspan="4" style="padding: 5px 5px; background: # | ! rowspan="4" style="padding: 5px 5px; background: #87CEFA; " | 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: # | ! rowspan="3" style="padding: 5px 5px; background: #87CEFA; " | Functional | ||
! style="padding: 5px 5px; background: #f0f8ff; " | Conversion disorder | ! style="padding: 5px 5px; background: #f0f8ff; " | Conversion disorder | ||
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Revision as of 15:08, 1 June 2018
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Acoustic neuroma Microchapters | |
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Case Studies | |
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Acoustic neuroma differential diagnosis On the Web | |
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American Roentgen Ray Society Images of Acoustic neuroma differential diagnosis | |
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Risk calculators and risk factors for Acoustic neuroma differential diagnosis | |
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 | ||
|---|---|---|
| Disease/Condition | Differentiating Signs/Symptoms | Findings on CT or MRI |
| Meningioma |
|
|
| Intracranial epidermoid cyst |
|
|
| Facial nerve schwannoma |
|
|
| Trigeminal schwannoma |
|
|
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.