Acoustic neuroma physical examination: Difference between revisions

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{{CMG}}{{AE}}{{Simrat}}
{{CMG}}{{AE}}{{Simrat}}
==Overview==
==Overview==
Common physical examination findings of acoustic neuroma include lateralization to the normal ear in [[Weber test]], decreased or absent [[ipsilateral]] [[corneal]] [[reflex]], and facial [[twitching]] or hypesthesia.
[[Patient|Patients]] with acoustic neuroma usually appear normal. [[Physical examination]] of [[Patient|patients]] with acoustic neuroma is usually remarkable for [[Sensorineural hearing loss]] in the affected [[ear]], positive [[Rinne test]], abnormal [[Weber test]], [[Papilledema]], [[Nystagmus]], [[Diplopia]] on [[lateral]] gaze, decreased or absent [[ipsilateral]] [[corneal]] [[reflex]], [[Face|facial]] [[twitching]] or [[hypesthesia]], [[Drooling]], [[Facial paralysis|drooping on one side of the face]], loss of taste , and [[ataxia]].


==Physical Examination==
==Physical Examination==
Diagnosis of acoustic neuromas begins with a history of asymmetric sensorineural hearing loss or other cranial nerve deficits according to the territory of involvement. Common physical examination findings of acoustic neuroma include lateralization to the normal ear in [[Weber test]], decreased or absent [[ipsilateral]] [[corneal]] [[reflex]], and facial [[twitching]] or hypesthesia.<ref>{{Cite journal
===Appearance of the Patient===
* [[Patient|Patients]] with acoustic neuroma usually appear normal.
 
===Vital Signs===
* [[Vital signs]] of [[patients]] with acoustic neuroma are usually within normal limits.
 
===Skin===
* [[Skin]] [[Physical examination|examination]] of [[Patient|patients]] with acoustic neuroma is usually normal.
 
===HEENT===
*[[Sensorineural hearing loss]] in the affected [[ear]]<ref>{{Cite journal
  | author = [[Robert W. Foley]], [[Shahram Shirazi]], [[Robert M. Maweni]], [[Kay Walsh]], [[Rory McConn Walsh]], [[Mohsen Javadpour]] & [[Daniel Rawluk]]
  | author = [[Robert W. Foley]], [[Shahram Shirazi]], [[Robert M. Maweni]], [[Kay Walsh]], [[Rory McConn Walsh]], [[Mohsen Javadpour]] & [[Daniel Rawluk]]
  | title = Signs and Symptoms of Acoustic Neuroma at Initial Presentation: An Exploratory Analysis
  | title = Signs and Symptoms of Acoustic Neuroma at Initial Presentation: An Exploratory Analysis
Line 39: Line 49:
  | pmid = 8971818
  | pmid = 8971818
}}</ref>
}}</ref>
===Ear Examination===
*Positive [[Rinne test]]
*[[Sensorineural hearing loss]] in the affected ear
*[[Weber test]] lateralizes to normal [[ear]]
*Rinne test is positive
 
*[[Rinne test]] is positive: air conduction > bone conduction (both air and bone conduction are decreased equally, but the difference between them is unchanged)
*[[Nystagmus]]
*[[Weber test]] lateralizes to normal ear
 
*[[Papilledema]]
*[[Diplopia]] on [[lateral]] gaze
 
===Neck===
* [[Neck]] [[Physical examination|examination]] of [[Patient|patients]] with acoustic neuroma is usually normal.
 
===Lungs===
* [[Respiratory examination|Pulmonary examination]] of [[Patient|patients]] with acoustic neuroma is usually normal.
 
===Heart===
* [[Circulatory system|Cardiovascular]] [[Physical examination|examination]] of [[Patient|patients]] with acoustic neuroma is usually normal.
 
===Abdomen===
* [[Abdominal examination]] of [[Patient|patients]] with acoustic neuroma is usually normal.
 
=== Back ===
* [[Human back|Back]] [[Physical examination|examination]] of [[Patient|patients]] with acoustic neuroma is usually normal.


===Eye examination===
=== Genitourinary ===
*[[Nystagmus]] may be present
* [[Genitourinary system|Genitourinary]] [[Physical examination|examination]] of [[Patient|patients]] with acoustic neuroma is usually normal.


*[[Papilledema]] may be present
===Neuromuscular===
*[[Diplopia]] on lateral gaze may be present
*[[Trigeminal nerve|Cranial nerve V]]- Decreased or absent [[ipsilateral]] [[corneal]] [[reflex]].
*[[Facial nerve|Cranial nerve VII]]- [[Face|Facial]] [[twitching]] or [[hypesthesia]], [[Drooling]], [[Facial paralysis|drooping on one side of the face]], and loss of taste
*[[Vestibulocochlear nerve|Cranial nerve VIII]]- Positive [[Rinne test]] and abnormal [[Weber test]]
*[[Glossopharyngeal nerve|Cranial nerve IX]]- Loss of taste in the [[Anatomical terms of location|posterior]] half of [[tongue]]
*[[Cerebellum]]- [[Ataxia]]


===Neurological Examination===
=== Extremities ===
Often, the physical exam is normal at the time the tumor is diagnosed. Occasionally, the following cranial nerves may be affected:
* [[Limb (anatomy)|Extremities]] [[Physical examination|examination]] of [[Patient|patients]] with acoustic neuroma is usually normal.
*[[Cranial nerve]] V- A decreased or absent [[ipsilateral]] [[corneal]] [[reflex]].
*Cranial nerve VII- Facial [[twitching]] or hypesthesia may occur. [[Drooling]] may occur. Drooping on one side of the [[face]] may occur. Loss of taste may occur.
*Cranial nerve VIII- In [[sensorineural]] hearing loss Rinne test is positive and Weber test is abnormal.
*Cranial nerve IX- the back half of the [[tongue]] can lose its sense of taste.
*Cerebellum: The following tests may be positive:
**[[Ataxia]] may be present.
*Romberg, Hall-Pike, and other balance tests are typically normal.


==References==
==References==

Revision as of 16:18, 26 April 2019

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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

Patients with acoustic neuroma usually appear normal. Physical examination of patients with acoustic neuroma is usually remarkable for Sensorineural hearing loss in the affected ear, positive Rinne test, abnormal Weber test, Papilledema, Nystagmus, Diplopia on lateral gaze, decreased or absent ipsilateral corneal reflex, facial twitching or hypesthesia, Drooling, drooping on one side of the face, loss of taste , and ataxia.

Physical Examination

Appearance of the Patient

  • Patients with acoustic neuroma usually appear normal.

Vital Signs

Skin

HEENT

Neck

Lungs

Heart

Abdomen

Back

Genitourinary

Neuromuscular

Extremities

References

  1. ↑ Robert W. Foley, Shahram Shirazi, Robert M. Maweni, Kay Walsh, Rory McConn Walsh, Mohsen Javadpour & Daniel Rawluk (2017). "Signs and Symptoms of Acoustic Neuroma at Initial Presentation: An Exploratory Analysis". Cureus. 9 (11): e1846. doi:10.7759/cureus.1846. PMID 29348989. Unknown parameter |month= ignored (help)
  2. ↑ Xiang Huang, Jian Xu, Ming Xu, Liang-Fu Zhou, Rong Zhang, Liqin Lang, Qiwu Xu, Ping Zhong, Mingyu Chen, Ying Wang & Zhenyu Zhang (2013). "Clinical features of intracranial vestibular schwannomas". Oncology letters. 5 (1): 57–62. doi:10.3892/ol.2012.1011. PMID 23255894. Unknown parameter |month= ignored (help)
  3. ↑ C. Matthies & M. Samii (1997). "Management of 1000 vestibular schwannomas (acoustic neuromas): clinical presentation". Neurosurgery. 40 (1): 1–9. PMID 8971818. Unknown parameter |month= ignored (help)

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