Acoustic neuroma differential diagnosis

Acoustic neuroma Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Acoustic neuroma from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography or Ultrasound
CT
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Acoustic neuroma differential diagnosis On the Web
Most recent articles
cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Acoustic neuroma differential diagnosis All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Acoustic neuroma differential diagnosis
CDC on Acoustic neuroma differential diagnosis
Acoustic neuroma differential diagnosis in the news
Blogs on Acoustic neuroma differential diagnosis
Directions to Hospitals Treating Acoustic neuroma
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.

Differential Diagnosis

Acoustic neuroma must be differentiated from:

• 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
• Neurofibroma
• Meniere's disease
• Bell's palsy

Differentiating features of common differential diagnosis are:

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 more prominent 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)